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General NPI Number Information
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NPI Number | 1104864370
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Entity Type | Organization
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Legal Business Name | RURAL HEALTH CLINICS OF WEST TN PLLC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 326 ASBURY AVE
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City | RIPLEY
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State | TN
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Zip | 38063-5577
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Country | US
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Telephone | 731-635-2755
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Fax | 731-635-8859
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Provider Business Mailing Address
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Address Line | PO BOX 1209
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City | DYERSBURG
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State | TN
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Zip | 38025-1209
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Country | US
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Telephone | 731-286-0149
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Fax | 731-286-6956
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MS. PAT F OWEN
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Credential |
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Telephone | 731-286-0149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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