# MEDWEST FAMILY PRACTICE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679612949
- **Authorized official:** LANCE GARDINER (ADMINISTRATOR)
- **Authorized official phone:** (615) 792-2292

## Contact information

- **Practice address:** 104 FREY ST, SUITE 100, ASHLAND CITY, TN 37015-1792
- **Practice address phone:** (615) 792-2292
- **Practice address fax:** (615) 792-2207
- **Mailing address:** PO BOX 24010, NASHVILLE, TN 37202-4010
- **Mailing address phone:** (615) 792-2292
- **Mailing address fax:** (615) 376-0199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 02/05/2007
- **Last updated:** 03/04/2008