Provider Demographics
NPI:1184063778
Name:WEST CLINIC, P.C.
Entity type:Organization
Organization Name:WEST CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-683-0055
Mailing Address - Street 1:100 N HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2146
Mailing Address - Country:US
Mailing Address - Phone:901-683-0055
Mailing Address - Fax:901-322-2955
Practice Address - Street 1:1251 WESLEY DR
Practice Address - Street 2:SUITE 107
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6442
Practice Address - Country:US
Practice Address - Phone:901-683-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704066Medicaid
TN3704066Medicaid