Provider Demographics
NPI:1871916072
Name:WESTBURY DIAGNOSTIC AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:WESTBURY DIAGNOSTIC AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA
Authorized Official - Phone:7213-729-5934
Mailing Address - Street 1:5600 S WILLOW DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-4713
Mailing Address - Country:US
Mailing Address - Phone:713-729-5934
Mailing Address - Fax:713-729-5945
Practice Address - Street 1:5600 S WILLOW DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-4713
Practice Address - Country:US
Practice Address - Phone:713-729-5934
Practice Address - Fax:713-729-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01617363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty