Provider Demographics
NPI:1457346702
Name:DUE WEST FAMILY HEALTHCARE INC
Entity Type:Organization
Organization Name:DUE WEST FAMILY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-868-2229
Mailing Address - Street 1:607 W DUE WEST AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4420
Mailing Address - Country:US
Mailing Address - Phone:615-868-2229
Mailing Address - Fax:931-393-2432
Practice Address - Street 1:607 W DUE WEST AVE STE 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4420
Practice Address - Country:US
Practice Address - Phone:615-868-2229
Practice Address - Fax:931-393-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD20429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1457346702OtherNPI
TN3373691OtherMEDICARE OTHER
TN3373691Medicaid
TN4044004OtherBCBS
TN10068525OtherAMERIGROUP
TN10068525OtherAMERIGROUP
TN3373691Medicare ID - Type Unspecified
TNCK5542OtherRAILROAD MEDICARE