Provider Demographics
NPI:1801110622
Name:EAST WEST HEALTH CENTER
Entity type:Organization
Organization Name:EAST WEST HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLETIER
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:941-744-9770
Mailing Address - Street 1:1216 13TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-7345
Mailing Address - Country:US
Mailing Address - Phone:941-744-9770
Mailing Address - Fax:941-527-0223
Practice Address - Street 1:1216 13TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-7345
Practice Address - Country:US
Practice Address - Phone:941-744-9770
Practice Address - Fax:941-527-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1663261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0790OtherBCBS