Healthcare Provider Details

I. General information

NPI: 1972557080
Provider Name (Legal Business Name): WESTGATE MEDICAL ANESTHESIA GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 LORAIN AVE
CLEVELAND OH
44111-5612
US

IV. Provider business mailing address

PO BOX 30
RAVENNA OH
44266-0030
US

V. Phone/Fax

Practice location:
  • Phone: 216-475-7052
  • Fax: 330-296-6535
Mailing address:
  • Phone: 800-485-2368
  • Fax: 330-296-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. WILLIAM VEBER
Title or Position: PRESIDENT
Credential: MD
Phone: 216-476-7052