Provider Demographics
NPI:1477568152
Name:WEST WILSON WALK-IN CLINIC, P.C.
Entity type:Organization
Organization Name:WEST WILSON WALK-IN CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-758-5672
Mailing Address - Street 1:4024 N MOUNT JULIET RD
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3086
Mailing Address - Country:US
Mailing Address - Phone:615-773-9393
Mailing Address - Fax:615-773-9238
Practice Address - Street 1:4024 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3086
Practice Address - Country:US
Practice Address - Phone:615-773-9393
Practice Address - Fax:615-773-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
3375589Medicare ID - Type Unspecified