Provider Demographics
NPI:1558825125
Name:DOWNTOWN WEST MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:DOWNTOWN WEST MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:INCANDELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-357-8861
Mailing Address - Street 1:1612 DOWNTOWN WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5408
Mailing Address - Country:US
Mailing Address - Phone:865-357-8861
Mailing Address - Fax:865-357-6666
Practice Address - Street 1:1612 DOWNTOWN WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5408
Practice Address - Country:US
Practice Address - Phone:865-357-8861
Practice Address - Fax:865-357-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty