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General NPI Number Information
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NPI Number | 1023180478
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Entity Type | Organization
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Legal Business Name | WEST CLINIC PC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 1500 W POPLAR AVE SUITE 304
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City | COLLIERVILLE
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State | TN
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Zip | 38017-0601
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Country | US
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Telephone | 901-850-1456
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Fax | 901-850-5830
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Provider Business Mailing Address
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Address Line | 100 N HUMPHREYS BLVD
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City | MEMPHIS
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State | TN
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Zip | 38120-2146
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Country | US
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Telephone | 901-683-0055
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Fax | 901-685-2969
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Authorized Official
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Title or Position | CFO
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Name | MR. RONALD O DAVIS
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Credential |
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Telephone | 901-683-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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