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Organization
WESTSHORE PRIMARY CARE ASSOC INC
Active
Organization
WESTSHORE PRIMARY CARE ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY A BLAYLOCK (CREDENTIALING COORDINATOR)
(440) 892-6406
Entity
Organization
Contact information
Practice address
2535 HALE ST, SUITE A, AVON, OH 44011
(440) 934-8810
(440) 934-8811
Mailing address
26908 DETROIT RD, SUITE 301, WESTLAKE, OH 44145-2398
(440) 617-1823
(440) 617-0884
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0858077
—
OH
Enumeration date
08/24/2006
Last updated
01/12/2010
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