=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801071451
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST CLINIC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2008
-----------------------------------------------------
Last Update Date | 06/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 HUMPHREYS CTR SUITE 100
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38120-2374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-683-0055
-----------------------------------------------------
Fax | 901-322-2970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 N HUMPHREYS BLVD
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-683-0055
-----------------------------------------------------
Fax | 901-322-2970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. STEVE M COPLON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-683-0055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------