Organization
WESTSHORE PRIMARY CARE ASSOC., INC.
Active
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
Update your record
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