Provider Demographics
NPI:1306941752
Name:WESTSIDE HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:WESTSIDE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-436-3040
Mailing Address - Street 1:480 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3634
Mailing Address - Country:US
Mailing Address - Phone:585-436-3040
Mailing Address - Fax:585-295-6009
Practice Address - Street 1:322 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-1017
Practice Address - Country:US
Practice Address - Phone:585-254-6480
Practice Address - Fax:585-295-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2701220R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355353Medicaid
NYG0182661590OtherBLUE CHOICE OF ROCHESTER
NYG0182661590OtherBLUE CHOICE OF ROCHESTER
NY10690AMedicare ID - Type UnspecifiedMCARE B GROUP NUMBER