Provider Demographics
NPI:1396048740
Name:WESTGATE HEALTH SERVICES, PLLC
Entity type:Organization
Organization Name:WESTGATE HEALTH SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCT MGR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-454-1234
Mailing Address - Street 1:3340 POPLAR AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4680
Mailing Address - Country:US
Mailing Address - Phone:901-454-1234
Mailing Address - Fax:901-454-0606
Practice Address - Street 1:3340 POPLAR AVE STE 215
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4680
Practice Address - Country:US
Practice Address - Phone:901-454-1234
Practice Address - Fax:901-454-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty