Basic Information
| Provider Information | |||||||||
| NPI: | 1720485865 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTROADS RHEUMATOLOGY ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 643 N 98TH ST # 253 | ||||||||
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| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681142370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023913800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10170 NICHOLAS ST | ||||||||
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| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681142174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023913800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2014 | ||||||||
| LastUpdateDate: | 12/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | PORNCHAISIRIARUN | ||||||||
| AuthorizedOfficialFirstName: | PETE | ||||||||
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| AuthorizedOfficialTitleorPosition: | IT DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 40220333881 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.