Healthcare Provider Details

I. General information

NPI: 1437436797
Provider Name (Legal Business Name): WEST CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HUMPHREYS BLVD
MEMPHIS TN
38120-2146
US

IV. Provider business mailing address

6215 HUMPHREYS BLVD SUITE 505
MEMPHIS TN
38120-2367
US

V. Phone/Fax

Practice location:
  • Phone: 901-322-9080
  • Fax: 901-322-2955
Mailing address:
  • Phone: 901-322-9080
  • Fax: 901-322-2955

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: MR. RON DAVIS
Title or Position: CFO
Credential:
Phone: 901-322-9080