Basic Information
| Provider Information | |||||||||
| NPI: | 1417942962 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTLAKE FAMILY PHYSICIANS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5623 W 19TH ST | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806342901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703539011 | ||||||||
| FaxNumber: | 9703530306 | ||||||||
| Practice Location | |||||||||
| Address1: | 5623 W 19TH ST | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806342901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703539011 | ||||||||
| FaxNumber: | 9703530306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 03/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCDOWELL | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9703539011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 04010583 | 05 | CO | MEDICAID |