Healthcare Provider Details

I. General information

NPI: 1124565999
Provider Name (Legal Business Name): WEST CLINIC, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8132 CORDOVA RD SUITE 101
CORDOVA TN
38016-6005
US

IV. Provider business mailing address

7714 POPLAR AVE SUITE 200
GERMANTOWN TN
38138-3941
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-0055
  • Fax: 901-685-2969
Mailing address:
  • Phone: 901-683-0055
  • Fax: 901-922-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3704066
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name: ERICH A MOUNCE
Title or Position: CEO
Credential:
Phone: 901-683-0055