Provider Demographics
NPI:1104864370
Name:RURAL HEALTH CLINICS OF WEST TN PLLC
Entity Type:Organization
Organization Name:RURAL HEALTH CLINICS OF WEST TN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:F
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-286-0149
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38025-1209
Mailing Address - Country:US
Mailing Address - Phone:731-286-0149
Mailing Address - Fax:731-286-6956
Practice Address - Street 1:326 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-5577
Practice Address - Country:US
Practice Address - Phone:731-635-2755
Practice Address - Fax:731-635-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730286Medicaid
TN443949Medicare Oscar/Certification
TN3730286Medicaid
TN3730286Medicare PIN