Healthcare Provider Details

I. General information

NPI: 1407139603
Provider Name (Legal Business Name): WESTERN FIRST ASSIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 CENTERVIEW DR SUITE 100
BRENTWOOD TN
37027-5274
US

IV. Provider business mailing address

214 CENTERVIEW DR SUITE 100
BRENTWOOD TN
37027-5274
US

V. Phone/Fax

Practice location:
  • Phone: 615-345-5390
  • Fax:
Mailing address:
  • Phone: 615-345-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN TOBIAS GRAY
Title or Position: PRESIDENT
Credential:
Phone: 615-345-5510