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General NPI Number Information
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NPI Number | 1033194303
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Entity Type | Organization
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Legal Business Name | WEST SIDE FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1909 W FRANKLIN ST
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City | EVANSVILLE
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State | IN
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Zip | 47712-5110
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Country | US
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Telephone | 812-456-9736
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Fax | 812-456-0140
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Provider Business Mailing Address
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Address Line | 1909 W FRANKLIN ST
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City | EVANSVILLE
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State | IN
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Zip | 47712-5110
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Country | US
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Telephone | 812-456-9736
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Fax | 812-456-0140
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY DONALD HUNTER
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Credential | M.D.
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Telephone | 812-456-9736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IN
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