Healthcare Provider Details

I. General information

NPI: 1104864370
Provider Name (Legal Business Name): RURAL HEALTH CLINICS OF WEST TN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 ASBURY AVE
RIPLEY TN
38063-5577
US

IV. Provider business mailing address

PO BOX 1209
DYERSBURG TN
38025-1209
US

V. Phone/Fax

Practice location:
  • Phone: 731-635-2755
  • Fax: 731-635-8859
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: OFFICE ADMINISTRATOR
Credential:
Phone: 731-286-0149