MEDICARE: WESTGATE HEALTH SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1396048740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTGATE HEALTH SERVICES, PLLC

Provider Business Mailing Address
First Line	:	3340 POPLAR AVE STE 215
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-4680
Country	:	US
Telephone Number	:	901-454-1234
Fax Number	:	901-454-0606

Provider Business Practice Location Address
First Line	:	3340 POPLAR AVE STE 215
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-4680
Country	:	US
Telephone Number	:	901-454-1234
Fax Number	:	901-454-0606

Authorized Official
Title or Position	:	ACCT MGR
Name	:	JENNIFER HODGES
Credential	:
Telephone Number	:	901-454-1234

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	06/27/2011

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