Provider Demographics
NPI:1679971550
Name:WESTGATE MEDICAL, LLC
Entity Type:Organization
Organization Name:WESTGATE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-400-0067
Mailing Address - Street 1:10858 E STATE ROAD 54
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:47424-6069
Mailing Address - Country:US
Mailing Address - Phone:812-400-0067
Mailing Address - Fax:812-400-0017
Practice Address - Street 1:10858 E STATE ROAD 54
Practice Address - Street 2:SUITE #1
Practice Address - City:BLOOMFIELD
Practice Address - State:IN
Practice Address - Zip Code:47424-6069
Practice Address - Country:US
Practice Address - Phone:812-400-0067
Practice Address - Fax:812-400-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363LF0000X
IN71002130A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ78851Medicare UPIN