Provider Demographics
NPI:1669775789
Name:WESTSIDE INTERNAL MEDICINE GROUP PLLC
Entity type:Organization
Organization Name:WESTSIDE INTERNAL MEDICINE GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OFORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-907-1055
Mailing Address - Street 1:7474 N COBBLESTONE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1307
Mailing Address - Country:US
Mailing Address - Phone:520-907-1055
Mailing Address - Fax:520-622-9845
Practice Address - Street 1:395 N SILVERBELL RD STE 107
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2718
Practice Address - Country:US
Practice Address - Phone:520-884-0752
Practice Address - Fax:520-622-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ957417Medicaid
1093793648OtherNPI
I42507Medicare UPIN
1093793648OtherNPI