Provider Demographics
NPI:1881761138
Name:WESTSIDE FAMILY MEDICAL CENTER PA
Entity type:Organization
Organization Name:WESTSIDE FAMILY MEDICAL CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-513-0067
Mailing Address - Street 1:1626 N PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5323
Mailing Address - Country:US
Mailing Address - Phone:850-513-0067
Mailing Address - Fax:850-561-6670
Practice Address - Street 1:1626 N PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5323
Practice Address - Country:US
Practice Address - Phone:850-513-0067
Practice Address - Fax:850-561-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty