MEDICARE: WEST WILSON FAMILY PRACTICE CENTER, P.C.

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1598779837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST WILSON FAMILY PRACTICE CENTER, P.C.

Provider Business Mailing Address
First Line	:	3500 N MOUNT JULIET RD
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-3078
Country	:	US
Telephone Number	:	615-758-5672
Fax Number	:	615-758-5609

Provider Business Practice Location Address
First Line	:	3500 N MOUNT JULIET RD
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-3078
Country	:	US
Telephone Number	:	615-758-5672
Fax Number	:	615-758-5609

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BERNARD PARE
Credential	:	M.D.
Telephone Number	:	615-758-5672

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/01/2010

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