Healthcare Provider Details

I. General information

NPI: 1407809627
Provider Name (Legal Business Name): HELOISE D WESTBROOK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W EVERLY BROTHERS BLVD STE II-C
POWDERLY KY
42367-5405
US

IV. Provider business mailing address

2233 W EVERLY BROTHERS BLVD STE II-C
POWDERLY KY
42367-5405
US

V. Phone/Fax

Practice location:
  • Phone: 270-641-0526
  • Fax: 270-641-0745
Mailing address:
  • Phone: 270-641-0526
  • Fax: 631-329-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: HELOISE D WESTBROOK
Title or Position: DIRECTOR
Credential: MD PHD
Phone: 270-641-0526