Provider Demographics
NPI:1962832717
Name:WESTSIDE GENERAL PRACTICE ASSOCIATES LTD
Entity Type:Organization
Organization Name:WESTSIDE GENERAL PRACTICE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-846-3186
Mailing Address - Street 1:6528 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-3329
Mailing Address - Country:US
Mailing Address - Phone:623-846-3186
Mailing Address - Fax:623-846-3757
Practice Address - Street 1:6528 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-3329
Practice Address - Country:US
Practice Address - Phone:623-846-3186
Practice Address - Fax:623-846-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1209261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE44448Medicare UPIN