MEDICARE: WESTSIDE HEALTHCARE LIMITED PARTNERSHIP

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	261QR0200X	Radiology Clinic/Center	0139IC	OH

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

General Provider Information

NPI Number	:	1609805423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE HEALTHCARE LIMITED PARTNERSHIP

Provider Business Mailing Address
First Line	:	25001 EMERY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-5626
Country	:	US
Telephone Number	:	216-831-9786
Fax Number	:	216-831-2425

Provider Business Practice Location Address
First Line	:	5260 SMITH RD
Second Line	:
City	:	BROOK PARK
State	:	OH
Zip	:	44142-1747
Country	:	US
Telephone Number	:	216-267-8080
Fax Number	:	216-267-0050

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. JEFFREY A. KAMPMAN
Credential	:	CPA
Telephone Number	:	216-831-9786

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	06/18/2009

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