MEDICARE: WESTRIDGE, OB/GYN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0000X	Obstetrics Physician

General Provider Information

NPI Number	:	1407262777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTRIDGE, OB/GYN

Provider Business Mailing Address
First Line	:	2545 W FRYE RD STE 5
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6273
Country	:	US
Telephone Number	:	480-821-3610
Fax Number	:	480-821-3610

Provider Business Practice Location Address
First Line	:	8410 W THOMAS RD STE 134
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3374
Country	:	US
Telephone Number	:	623-907-2377
Fax Number	:	480-821-3610

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	HEATHER HARNER
Credential	:
Telephone Number	:	480-821-3610

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	07/08/2014

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