Healthcare Provider Details

I. General information

NPI: 1942584594
Provider Name (Legal Business Name): WEST CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 W BRIERBROOK RD
GERMANTOWN TN
38138-2208
US

IV. Provider business mailing address

PO BOX 240728
MEMPHIS TN
38124-0728
US

V. Phone/Fax

Practice location:
  • Phone: 901-692-9600
  • Fax: 901-692-9609
Mailing address:
  • Phone: 901-737-1992
  • Fax: 901-309-8784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RON DAVIS
Title or Position: CFO
Credential:
Phone: 901-683-0055