Provider Demographics
NPI:1396801007
Name:PROFESSIONAL CARE SERVICES OF WEST TN INC
Entity type:Organization
Organization Name:PROFESSIONAL CARE SERVICES OF WEST TN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-476-8967
Mailing Address - Street 1:1997 HWY 51 S
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3630
Mailing Address - Country:US
Mailing Address - Phone:901-476-8967
Mailing Address - Fax:901-318-1125
Practice Address - Street 1:12615 S MAIN
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-1673
Practice Address - Country:US
Practice Address - Phone:901-465-9831
Practice Address - Fax:901-465-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4428252OtherNCPDP