Flavia H West MD
Organization Active NPI Family Medicine Physician · Pontotoc, MS
NPI 1386982569 · NPPES record last updated Jan 23, 2013
Key facts
- NPI
- 1386982569
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 10750 (MS)
- Legal business name
- FLAVIA H WEST MD
- Practice address
- 183 S Main St
Pontotoc, MS 38863-3209 - Phone
- (662) 489-5038
- Fax
- (662) 489-7004
- NPI assigned
- Jan 23, 2013
- Organization subpart
- No
Authorized official
- Name
- Flavia H West, MD
- Title
- Owner
- Phone
- (662) 489-5038
Practitioners 2
-
Amber Claire Brown, NP-C
-
Flavia H West, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D0317158 | Flavia H West MD | Certificate of waiver | Jan 24, 2027 |
National Provider Directory
Locations
183 S Main St
Pontotoc, MS 38863
Phone (662) 488-9793
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 10750 | MS | Yes |
Addresses
Primary practice location
183 S Main St
Pontotoc, MS 38863-3209
Mailing address
183 S Main St
Pontotoc, MS 38863-3209
Phone (662) 489-5038
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00019567 | Medicaid | MS |
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All providers in Pontotoc, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.