Provider Demographics
NPI:1679786073
Name:WEST UNION CLINIC
Entity Type:Organization
Organization Name:WEST UNION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-534-0033
Mailing Address - Street 1:1561 HWY 30 WEST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE
Mailing Address - State:MS
Mailing Address - Zip Code:38650
Mailing Address - Country:US
Mailing Address - Phone:662-534-0033
Mailing Address - Fax:662-539-0039
Practice Address - Street 1:1561 HWY 30 WEST
Practice Address - Street 2:
Practice Address - City:MYRTLE
Practice Address - State:MS
Practice Address - Zip Code:38650
Practice Address - Country:US
Practice Address - Phone:662-534-0033
Practice Address - Fax:662-539-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860041163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS428614032AOtherBCBS
MS06021701Medicaid
MS03156350Medicaid
MS06021701Medicaid