Provider Demographics
NPI:1386828416
Name:WESTLAKES PRIMARY CARE, PA
Entity type:Organization
Organization Name:WESTLAKES PRIMARY CARE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BELLUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAMANATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-674-6130
Mailing Address - Street 1:8637 FREDERICKSBURG RD
Mailing Address - Street 2:#360
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1285
Mailing Address - Country:US
Mailing Address - Phone:210-949-4179
Mailing Address - Fax:210-617-4075
Practice Address - Street 1:8303 MILITARY DR W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1841
Practice Address - Country:US
Practice Address - Phone:210-674-6130
Practice Address - Fax:210-674-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8403208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00L41SMedicare PIN
TXF41518Medicare UPIN