MEDICARE: WESTBROOK OB/GYN, INC.

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	174400000X	Specialist		OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	WE9264621	OTHER	OH	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000163741	OTHER	OH	ANTHEM
4	000000182566	OTHER	OH	UNISON
5	734099	OTHER		BUCKEYE
6	104605	OTHER	OH	KAISER
7	2012181	OTHER	OH	HOMETOWN HEALTH

General Provider Information

NPI Number	:	1770779720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTBROOK OB/GYN, INC.

Provider Business Mailing Address
First Line	:	2525 13TH ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-3118
Country	:	US
Telephone Number	:	330-455-5231
Fax Number	:	330-455-1403

Provider Business Practice Location Address
First Line	:	2525 13TH ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-3118
Country	:	US
Telephone Number	:	330-455-5231
Fax Number	:	330-455-1403

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	VICTOR HIRAM BAZZOLI
Credential	:	M.D.
Telephone Number	:	330-455-5231

Provider Enumeration Date	:	09/23/2007
Last Update Date	:	07/21/2008

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Directions to “WESTBROOK OB/GYN, INC. ” Practice Location

Language	Start Address	Practice Location

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