Provider Demographics
NPI:1285767673
Name:WESTSIDE GASTROENTEROLOGISTS, INC.
Entity type:Organization
Organization Name:WESTSIDE GASTROENTEROLOGISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:440-816-4547
Mailing Address - Street 1:7255 OLD OAK BLVD
Mailing Address - Street 2:SUITE C412
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3329
Mailing Address - Country:US
Mailing Address - Phone:440-816-4546
Mailing Address - Fax:440-816-4549
Practice Address - Street 1:7255 OLD OAK BLVD
Practice Address - Street 2:SUITE C412
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-816-4546
Practice Address - Fax:440-816-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2211485Medicaid
OH9924012Medicare ID - Type UnspecifiedPARMA OFFICE
OH9924011Medicare ID - Type UnspecifiedSOUTHWEST OFFICE