Provider Demographics
NPI:1467472688
Name:WEST CLINIC ASTC
Entity Type:Organization
Organization Name:WEST CLINIC ASTC
Other - Org Name:WEST CLINIC, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-683-0055
Mailing Address - Street 1:7714 POPLAR AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3941
Mailing Address - Country:US
Mailing Address - Phone:901-683-0055
Mailing Address - Fax:901-685-2969
Practice Address - Street 1:7945 WOLF RIVER BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-683-0055
Practice Address - Fax:901-685-2969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST CLINIC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9013755Medicaid
TN3288607Medicaid
MO500557509Medicaid
AR8P003OtherBCBS AR
AR132175002Medicaid
TN0106442OtherBCBS TN
AR132175002Medicaid
TN0106442OtherBCBS TN
MS=========OtherBCBS MS
MS=========OtherBCBS MS
MS9013755Medicaid