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
29325 HEALTH CAMPUS DR, SUITE 1, WESTLAKE, OH 44145-8201
(440) 835-6996
(440) 808-9738
Mailing address
26908 DETROIT RD, SUITE 301, WESTLAKE, OH 44145-2398
(440) 617-1823
(440) 617-0884
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0858077
—
OH
Enumeration date
12/14/2010
Last updated
12/14/2010
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