West Family Care Clinic PLLC
Organization Active NPI Rural Health Clinic/Center · Newbern, TN
NPI 1285008367 · NPPES record last updated Jun 25, 2024
Key facts
- NPI
- 1285008367
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- WEST FAMILY CARE CLINIC PLLC
- Practice address
- 100 E Highway 77
Newbern, TN 38059-1169 - Phone
- (731) 627-3553
- Fax
- (731) 882-1256
- NPI assigned
- Nov 30, 2015
- Organization subpart
- No
Authorized official
- Name
- Laura Beth West, FNP-C
- Title
- Owner, Nurse Practitioner
- Phone
- (731) 627-3553
Owners & managing parties with NPI records 1
Practitioners 6
-
Syble S Carter, FNP
-
Lillian H Rinker, MD
-
Martha K Tibbs, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Rural health clinic certification: CCN 448974
- Legal name
- WEST FAMILY CARE CLINIC PLLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 16, 2017
- Last certification
- Feb 16, 2017
- Ownership / control type
- 1A
- Organization structure
- LLC · Proprietary
- Enrollment address
- 100 E Highway 77
Newbern, TN 38059-1169
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Gregory West |
W-2 Managing Employee | Aug 1, 2022 | |
| Operational/Managerial Control | Nov 6, 2016 | 80% | |
| Laura B West |
5% Or Greater Direct Ownership Interest | Aug 1, 2022 | 100% |
| Corporate Officer |
Aug 1, 2022 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161006001224 | TN | Part a Provider - Rural Health Clinic | 8921396912 | Practice locations: Newbern, TN |
| O20221207000475 | TN | Part B Supplier - Clinic/Group Practice | 8921396912 |
Receives reassigned benefits from 4 practitioners Practice locations: Newbern, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
100 E Highway 77
Newbern, TN 38059-1169
Mailing address
100 E Highway 77
Newbern, TN 38059-1169
Phone (731) 627-3553
Other names
- West Family Care Clinic
Other providers in Newbern, TN
- Newbern Medical Clinic, PC
- Presley Diabetes and Endocrine Center, PLLC
- Kagan Marie Qualls
- Logan J Rummells
- Wanda Faye Smith
- Laura West
All providers in Newbern, TN · Rural Health Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.