Healthcare Provider Details

I. General information

NPI: 1992992416
Provider Name (Legal Business Name): RURAL HEALTH CLINICS OF WEST TN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E MAIN ST
HALLS TN
38040-1523
US

IV. Provider business mailing address

PO BOX 1209
DYERSBURG TN
38025-1209
US

V. Phone/Fax

Practice location:
  • Phone: 731-836-7700
  • Fax: 731-836-7777
Mailing address:
  • Phone: 731-286-0149
  • Fax: 731-286-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MS. PAT F OWEN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 731-286-0149