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NPI Code Detail

MEDICARE: FAMILY MEDICINE WEST PLLC

MEDICARE: FAMILY MEDICINE WEST PLLC
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
1261QR1300XRural Health Clinic/CenterTN

General Provider Information

NPI Number : 1902292865
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY MEDICINE WEST PLLC
Provider Business Mailing Address
First Line : 220 FORT SANDERS WEST BLVD
Second Line : BUILDING 2, SUITE 200
City : KNOXVILLE
State : TN
Zip : 37922-3398
Country : US
Telephone Number : 423-346-5566
Fax Number : 423-346-5631
Provider Business Practice Location Address
First Line : 1236 KNOXVILLE HWY
Second Line : SUITE 500
City : WARTBURG
State : TN
Zip : 37887-4200
Country : US
Telephone Number : 423-346-5566
Fax Number : 423-346-5631
Authorized Official
Title or Position : MD/PRESIDENT
Name : DR. SANJAY P THANKUR
Credential : M.D.
Telephone Number : 423-346-5566
Provider Enumeration Date : 04/07/2015
Last Update Date : 04/07/2015

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Directions to “FAMILY MEDICINE WEST PLLC ” Practice Location

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