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1110 A Ted Crozier Sr. Blvd Clarksville TN 37043-8912 | |
| (931) 538-3039 | |
| (931) 245-5484 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 1110 A Ted Crozier Sr. Blvd, Clarksville, Tennessee |
| Authorized Official Name and Position | Jigar Kanubhai Shah (PROVIDER/CO-OWNER) |
| Authorized Official Contact | 9318028056 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1960 Madison St Pmb 326 Clarksville TN 37043-8063 Ph: (931) 538-3039 | 1110 A Ted Crozier Sr. Blvd Clarksville TN 37043-8912 Ph: (931) 538-3039 |
| NPI Number | 1629857248 |
|---|---|
| Provider Enumeration Date | 09/22/2023 |
| Last Update Date | 01/23/2025 |
| Medicare PECOS PAC ID | 4486187606 |
|---|---|
| Medicare Enrollment ID | O20241028000056 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629857248 | NPI | - | NPPES |
| Provider Name | Jigar K Shah |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1013936079 PECOS PAC ID: 8426079435 Enrollment ID: I20051216000669 |
| Provider Name | Michael S West |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467462077 PECOS PAC ID: 3476551151 Enrollment ID: I20061113000051 |
| Provider Name | Elizabeth Bator |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023489556 PECOS PAC ID: 6800190935 Enrollment ID: I20241205000533 |
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