Provider Demographics
NPI:1609905207
Name:WEBSTER MEDICAL GROUP, PC.
Entity Type:Organization
Organization Name:WEBSTER MEDICAL GROUP, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-872-8442
Mailing Address - Street 1:45 WEBSTER COMMONS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3813
Mailing Address - Country:US
Mailing Address - Phone:585-872-0650
Mailing Address - Fax:585-872-2474
Practice Address - Street 1:45 WEBSTER COMMONS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-3813
Practice Address - Country:US
Practice Address - Phone:585-872-0650
Practice Address - Fax:585-872-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty