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Organization

WESTSHORE PRIMARY CARE ASSOC., INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISTY BLAYLOCK (CREDENTIALING COORDINATOR)
(440) 892-6406
Entity
Organization

Contact information

Practice address
33398 WALKER RD, SUITE C, AVON LAKE, OH 44012-1496
(440) 930-8630
(440) 930-8676
Mailing address
26908 DETROIT RD, SUITE 301, WESTLAKE, OH 44145-2398
(440) 617-1823
(440) 617-0884

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
208000000X
Pediatrics Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0858077
OH
Enumeration date
09/11/2009
Last updated
09/11/2009
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