Provider Demographics
NPI:1043499536
Name:WESTSIDE UROLOGY, INC
Entity type:Organization
Organization Name:WESTSIDE UROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-878-0077
Mailing Address - Street 1:108 N MURRAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1524
Mailing Address - Country:US
Mailing Address - Phone:614-878-0077
Mailing Address - Fax:614-870-9117
Practice Address - Street 1:108 N MURRAY HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1524
Practice Address - Country:US
Practice Address - Phone:614-878-0077
Practice Address - Fax:614-870-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH189401948005OtherMEDICAL MUTUAL OF OHIO
OH0487941Medicaid
1466066OtherUMWA
OH4391061OtherAETNA
1900129OtherUHC
0280OtherMUTUAL OF OMAHA
=========OtherTRICARE
OH0487941Medicaid