Organization
WEST TENNESSEE PRIMARY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAMERON BURKS (PRACTICE ADMINISTRATOR)
(731) 608-0380
Entity
Organization
Contact information
Practice address
541 W PARK PL, HENDERSON, TN 38340-2027
(731) 989-1007
(731) 989-0704
Mailing address
541 W PARK PL, HENDERSON, TN 38340-2027
(731) 989-1007
(731) 989-0704
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
443960
MEDICARE PTAN FOR RURAL HEALTH CLINIC
TN
Enumeration date
11/13/2018
Last updated
12/29/2023
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