Provider Demographics
NPI:1437589876
Name:RURAL HEALTH CLINIC OF WEST TN PLLC
Entity Type:Organization
Organization Name:RURAL HEALTH CLINIC OF WEST TN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:S
Authorized Official - Last Name:BINDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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:731-285-3300
Mailing Address - Fax:731-285-3370
Practice Address - Street 1:1716 PARR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2073
Practice Address - Country:US
Practice Address - Phone:731-285-3300
Practice Address - Fax:731-285-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1104864370Medicaid