Provider Demographics
NPI:1427303676
Name:WEST CENTER PEDIATRICS PC
Entity type:Organization
Organization Name:WEST CENTER PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-991-7337
Mailing Address - Street 1:11602 W CENTER RD STE 150
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4447
Mailing Address - Country:US
Mailing Address - Phone:402-991-7337
Mailing Address - Fax:402-991-7373
Practice Address - Street 1:11602 W CENTER RD STE 150
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4447
Practice Address - Country:US
Practice Address - Phone:402-991-7337
Practice Address - Fax:402-991-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty