Organization
WEST CLINIC ASTC
Active
Parent organization
WEST CLINIC, PC
Other names
West Clinic, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WEST CLINIC, PC
Authorized official
MR. RON M DAVIS (CFO)
(901) 683-0055
Entity
Organization
Contact information
Practice address
7945 WOLF RIVER BLVD, GERMANTOWN, TN 38138
(901) 683-0055
(901) 685-2969
Mailing address
7714 POPLAR AVE STE 200, GERMANTOWN, TN 38138-3941
(901) 683-0055
(901) 685-2969
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0106442
BCBS TN
TN
05
—
132175002
—
AR
05
—
3288607
—
TN
05
—
500557509
—
MO
01
—
8P003
BCBS AR
AR
05
—
9013755
—
MS
Enumeration date
07/20/2006
Last updated
08/20/2018
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