Provider Demographics
NPI:1972572402
Name:WESTSIDE ORTHOPAEDICS, P.C.
Entity Type:Organization
Organization Name:WESTSIDE ORTHOPAEDICS, P.C.
Other - Org Name:WESTSIDE OCCUPATIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-582-6202
Mailing Address - Street 1:4005 WESTMARK DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2271
Mailing Address - Country:US
Mailing Address - Phone:563-582-6202
Mailing Address - Fax:563-582-5909
Practice Address - Street 1:4005 WESTMARK DR
Practice Address - Street 2:STE. 200
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2271
Practice Address - Country:US
Practice Address - Phone:563-582-6202
Practice Address - Fax:563-582-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0274902Medicaid
IA0493900001Medicare NSC
IL0493900002Medicare NSC
IA0274902Medicaid
IAI6315Medicare PIN
WI0493900002Medicare NSC