MEDICARE: WESTSIDE PRIMARY CARE, LLC

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	3504319	OH

General Provider Information

NPI Number	:	1720520612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE PRIMARY CARE, LLC

Provider Business Mailing Address
First Line	:	4342 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3322
Country	:	US
Telephone Number	:	513-898-9111
Fax Number	:	844-519-2824

Provider Business Practice Location Address
First Line	:	4342 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3322
Country	:	US
Telephone Number	:	513-898-9111
Fax Number	:	844-519-2824

Authorized Official
Title or Position	:	BILLING ADMIN.
Name	:	MRS. SHANNON DICECCO
Credential	:
Telephone Number	:	513-898-9111

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	12/14/2016

Similar Medicare Providers

1316088214 — DR. MICHAEL N. MILLER D.C.
Practice Location Address:

4342 HARRISON AVE STE 1
CINCINNATI, OH
45211-3322

Practice Phone: 513-598-9700
Practice Fax: 513-598-9701

1316129471 — MILLER FAMILY CHIROPRACTIC INC
Practice Location Address:

4342 HARRISON AVE STE 1
CINCINNATI, OH
45211-3322

Practice Phone: 513-598-9700
Practice Fax: 513-598-9701

1457584583 — MS. ORIENTA NICOLE EISON MA, LPCC
Practice Location Address:

1882 ROOSEVELT AVE
CINCINNATI, OH
45240-3322

Practice Phone: 513-788-1766
Practice Fax:

1942580725 — EMERGING SPIRIT COUNSELING SERVICES, LLC
Practice Location Address:

1882 ROOSEVELT AVE
CINCINNATI, OH
45240-3322

Practice Phone: 513-788-1766
Practice Fax:

1578916607 — BEHAVIORAL INTERVENTION AND CONSULTING
Practice Location Address:

3322 ERIE AVE , SUITE 4
CINCINNATI, OH
45208-1655

Practice Phone: 513-492-2374
Practice Fax:

1164875258 — EVA CAVILEER BCBA
Practice Location Address:

3322 ERIE AVE , SUITE 4
CINCINNATI, OH
45208-1655

Practice Phone: 513-492-2374
Practice Fax:

Directions to “WESTSIDE PRIMARY CARE, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.