Provider Demographics
NPI:1851530240
Name:THE WEST CLINIC, PLLC
Entity type:Organization
Organization Name:THE WEST CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-322-9080
Mailing Address - Street 1:1710 SHELBY OAKS DR N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7403
Mailing Address - Country:US
Mailing Address - Phone:901-201-5470
Mailing Address - Fax:901-201-5465
Practice Address - Street 1:7945 WOLF RIVER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1768
Practice Address - Country:US
Practice Address - Phone:901-201-5470
Practice Address - Fax:901-201-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROS02363332B00000X
AL1140383336C0003X
MS12015/7.13336C0003X
3336C0003X
TN46153336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138498OtherPK
TN1851530240Medicaid
2138498OtherPK
AR214515407Medicaid
MO1851530240Medicaid
103G872050Medicare PIN