MEDICARE: WEST UNION CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R860041	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	428614032A	OTHER	MS	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679786073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST UNION CLINIC

Provider Business Mailing Address
First Line	:	1561 HWY 30 WEST
Second Line	:
City	:	MYRTLE
State	:	MS
Zip	:	38650
Country	:	US
Telephone Number	:	662-534-0033
Fax Number	:	662-539-0039

Provider Business Practice Location Address
First Line	:	1561 HWY 30 WEST
Second Line	:
City	:	MYRTLE
State	:	MS
Zip	:	38650
Country	:	US
Telephone Number	:	662-534-0033
Fax Number	:	662-539-0039

Authorized Official
Title or Position	:	OWNER
Name	:	APRIL ROBBINS
Credential	:	FNP
Telephone Number	:	662-534-0033

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/11/2008

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Directions to “WEST UNION CLINIC ” Practice Location

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