Provider Demographics
NPI:1801071451
Name:WEST CLINIC, PC
Entity type:Organization
Organization Name:WEST CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COPLON
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
Mailing Address - Country:US
Mailing Address - Phone:901-683-0055
Mailing Address - Fax:901-322-2970
Practice Address - Street 1:55 HUMPHREYS CTR
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2374
Practice Address - Country:US
Practice Address - Phone:901-683-0055
Practice Address - Fax:901-322-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013755Medicaid
TN0106442OtherTN BCBS
MO500557509Medicaid
AR132175002Medicaid
TN3704066Medicaid
AR8P003OtherAR BCBS
AR8P003OtherAR BCBS
MS=========OtherMS BCBS
AR132175002Medicaid
MO500557509Medicaid
TN0106442OtherTN BCBS
TNCN1272Medicare PIN