Provider Demographics
NPI:1255149829
Name:WEST EASTERN HEALTH
Entity type:Organization
Organization Name:WEST EASTERN HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-242-9565
Mailing Address - Street 1:4210 VALLEY RIDGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5171
Mailing Address - Country:US
Mailing Address - Phone:904-593-8480
Mailing Address - Fax:904-593-7980
Practice Address - Street 1:4210 VALLEY RIDGE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32081-5171
Practice Address - Country:US
Practice Address - Phone:904-593-8480
Practice Address - Fax:904-593-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-27
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1245525781OtherFLORIDA MEDICAL LICENSE