| West Tennessee Primary Care, Llc | |
|
541 W Park Pl Henderson TN 38340-2027 | |
| (731) 989-1007 | |
| (731) 989-0704 |
| Full Name | West Tennessee Primary Care, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 541 W Park Pl, Henderson, Tennessee |
| Authorized Official Name and Position | Cameron Burks (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 7316080380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Tennessee Primary Care, Llc 541 W Park Pl Henderson TN 38340-2027 Ph: (731) 989-1007 | West Tennessee Primary Care, Llc 541 W Park Pl Henderson TN 38340-2027 Ph: (731) 989-1007 |
| NPI Number | 1942779509 |
|---|---|
| Provider Enumeration Date | 11/13/2018 |
| Last Update Date | 12/29/2023 |
| Medicare PECOS PAC ID | 1355681693 |
|---|---|
| Medicare Enrollment ID | O20190513000625 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942779509 | NPI | - | NPPES |
| 443960 | Other | TN | MEDICARE PTAN FOR RURAL HEALTH CLINIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Traci K Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235410481 PECOS PAC ID: 7618133224 Enrollment ID: I20120726000420 |
| Provider Name | Cheryl Lynn Middleton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851721385 PECOS PAC ID: 6709017189 Enrollment ID: I20140327002209 |
| Provider Name | Aley H Hamadani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659637924 PECOS PAC ID: 2769621770 Enrollment ID: I20151027001489 |
| Provider Name | Stephanie M Coley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962922120 PECOS PAC ID: 7517389232 Enrollment ID: I20200629000861 |
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