Provider Demographics
NPI:1720485865
Name:WESTROADS RHEUMATOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:WESTROADS RHEUMATOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORNCHAISIRIARUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:4022-033-3881
Mailing Address - Street 1:643 N 98TH ST # 253
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2370
Mailing Address - Country:US
Mailing Address - Phone:402-391-3800
Mailing Address - Fax:
Practice Address - Street 1:10170 NICHOLAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2174
Practice Address - Country:US
Practice Address - Phone:402-391-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty