Healthcare Provider Details

I. General information

NPI: 1174826572
Provider Name (Legal Business Name): WESTGATE HEALTH SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4466 ELVIS PRESLEY BLVD STE 200
MEMPHIS TN
38116-7100
US

IV. Provider business mailing address

4466 ELVIS PRESLEY BLVD STE 200
MEMPHIS TN
38116-7100
US

V. Phone/Fax

Practice location:
  • Phone: 901-344-7860
  • Fax: 901-396-9087
Mailing address:
  • Phone: 901-344-7860
  • Fax: 901-396-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HODGES
Title or Position: ACCT MGR
Credential:
Phone: 901-344-7860