Organization
WEST CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD O DAVIS (CFO)
(901) 683-0055
Entity
Organization
Contact information
Practice address
1500 W POPLAR AVE, SUITE 304, COLLIERVILLE, TN 38017-0601
(901) 850-1456
(901) 850-5830
Mailing address
100 N HUMPHREYS BLVD, MEMPHIS, TN 38120-2146
(901) 683-0055
(901) 685-2969
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0106442
BCBS TN
TN
05
—
09013755
—
MS
05
—
132175002
—
AR
05
—
3704066
—
TN
05
—
500557509
—
MO
01
—
8P003
BCBS AR
AR
Enumeration date
11/14/2006
Last updated
10/20/2011
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