Basic Information
| Provider Information | |||||||||
| NPI: | 1528319357 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST CLINIC, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N. HUMPHREYS BLVD. | ||||||||
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| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016830055 | ||||||||
| FaxNumber: | 9016852969 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 WOLF RIVER BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381381754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016929600 | ||||||||
| FaxNumber: | 9016929606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2012 | ||||||||
| LastUpdateDate: | 09/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | MOUNCE | ||||||||
| AuthorizedOfficialFirstName: | ERICH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9016830055 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WEST CLINIC, P.C. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.