Provider Demographics
NPI:1750688479
Name:WEST TENNESSEE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:WEST TENNESSEE MEDICAL GROUP, INC.
Other - Org Name:MEDSOUTH MEDICAL CENTER, DYERSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-541-6730
Mailing Address - Street 1:1700 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2028
Mailing Address - Country:US
Mailing Address - Phone:731-287-4500
Mailing Address - Fax:731-287-4804
Practice Address - Street 1:1700 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2028
Practice Address - Country:US
Practice Address - Phone:731-287-4500
Practice Address - Fax:731-287-4804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST TENNESSEE MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-15
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center