Provider Demographics
NPI:1902230964
Name:WESTOVER PRIMARY CARE
Entity Type:Organization
Organization Name:WESTOVER PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-802-3777
Mailing Address - Street 1:8910 WHITNEY CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5706
Mailing Address - Country:US
Mailing Address - Phone:210-802-3777
Mailing Address - Fax:
Practice Address - Street 1:9026 CULEBRA RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2882
Practice Address - Country:US
Practice Address - Phone:210-802-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty