Organization
WEST CLINIC PC
Active
Other names
Memphis Heart Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD O DAVIS (CFO)
(901) 683-0055
Entity
Organization
Contact information
Practice address
6025 WALNUT GROVE RD, STE. 111, MEMPHIS, TN 38120-2102
(901) 818-0300
(901) 818-0458
Mailing address
100 N HUMPHREYS BLVD, MEMPHIS, TN 38120-2146
(901) 683-0055
(901) 322-9097
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015177
—
MS
05
—
3704068
—
TN
01
—
7100204
AETNA
TN
01
—
8P003
BCBS
AR
01
—
CH5373
RAIL ROAD MEDICARE
MS
01
—
CN1272
RAIL ROAD MEDICARE
TN
Enumeration date
01/11/2007
Last updated
11/10/2011
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