WEST TENNESSEE MEDICAL GROUP INC (NPI# 1053615955) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053615955 |
| Entity Type | Organization |
| Organization Name | WEST TENNESSEE MEDICAL GROUP INC |
| Practice Address |
620 Skyline Dr Jackson TN 38301-3923 |
| Mailing Address |
1804 Highway 45 Byp Ste 604 Jackson TN 38305-4403 |
| Practice Telephone | 7316608730 |
| Practice Fax Number | 7316608739 |
| Mailing Telephone | 7316608730 |
| Mailing Fax Number | 7316608739 |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2018-12-20 |
| Authorized Official Name | BARTLEY TEAGUE (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7315121277 |
| Is Organization Subpart | Y |
| Parent Organization Name | JACKSON MADISON COUNTY GENERAL HOSPITAL DISTRICT |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 2084S0012X |
Psychiatry & Neurology Specialization: Sleep Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0127X |
Surgery Specialization: Trauma Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians | ||
| N | 208M00000X | Hospitalist | Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164987236 | West Tennessee Medical Group Inc | Surgery | 395 Hospital Blvd, Jackson, TN 38305-2080 | 2019-02-04 |
| 1851835367 | West Tennessee Medical Group Inc | Family Medicine | 270 E Court Ave, Suite B, Selmer, TN 38375-2304 | 2016-12-19 |
| 1184959207 | West Tennessee Medical Group Inc | Durable Medical Equipment & Medical Supplies | 1700 Woodlawn Ave, Dyersburg, TN 38024-2028 | 2009-10-07 |
| 1538494653 | West Tennessee Medical Group Inc | Durable Medical Equipment & Medical Supplies | 655 Lexington Ave, Jackson, TN 38301-5075 | 2009-10-07 |
| 1275868390 | West Tennessee Medical Group Inc | Durable Medical Equipment & Medical Supplies | 700 W Forest Ave, Suite 200, Jackson, TN 38301-3937 | 2009-10-07 |
| Street Address |
620 SKYLINE DR |
| City | JACKSON |
| State | TN |
| Zip Code | 38301-3923 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821094608 | Julie A Mcbroom | Nurse Anesthetist, Certified Registered | 620 Skyline Dr, Jackson, TN 38301-3923 | 2005-06-25 |
| 1205440260 | Heather Middleton | Registered Nurse | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-09-06 |
| 1780297291 | Holly R Jones | Nurse Practitioner | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-08-25 |
| 1851909972 | Earl Wade Lomax | Student in an Organized Health Care Education/Training Program | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-07-15 |
| 1356960835 | Gregory Heath Mcneely | Registered Nurse | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-04-14 |
| 1174157515 | Matthew Lee Luttrell | Nurse Practitioner | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-02-25 |
| 1528698594 | Heidi Hill | Nurse Practitioner | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-01-18 |
| 1407406861 | Justin Harrison | Nurse Anesthetist, Certified Registered | 620 Skyline Dr, Jackson, TN 38301-3923 | 2019-09-18 |
| 1770131856 | Shelby Kathryn Berry | Nurse Anesthetist, Certified Registered | 620 Skyline Dr, Jackson, TN 38301-3923 | 2019-08-30 |
| 1891342028 | Jack Harold Fields IIi | Nurse Anesthetist, Certified Registered | 620 Skyline Dr, Jackson, TN 38301-3923 | 2019-08-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124634696 | Lindsey Crowder | Social Worker | 127 Mccowat Street, Jackson, TN 38301 | 2020-09-21 |
| 1366928087 | Primary Care - South Limited | Clinic/Center | 1385 South Highland Ave, Suite B-1, Jackson, TN 38301 | 2018-07-16 |
| 1629592522 | Tlc Home Care Services, LLC | In Home Supportive Care | 39 Old Denmark Rd, Jackson, TN 38301 | 2017-08-01 |
| 1841730421 | Southern Hands Quality Care | In Home Supportive Care | 1298 N. Highland Avenue. Suite 14, Jackson, TN 38301 | 2017-03-02 |
| 1881044477 | Katie Mcmickin | Counselor | 163 Sunnyside Dr, Jackson, TN 38301 | 2016-06-15 |
| 1164815064 | Hailey Archer | Dietitian, Registered | 720 W. Forest Ave., Jackson, TN 38301 | 2015-03-17 |
| 1740673714 | Regina Tignor | Nurse Practitioner | 1410 Us Highway 70 Byp, Jackson, TN 38301 | 2015-03-13 |
| 1194114033 | Woman's Clinic | Obstetrics & Gynecology | 242 Coatsland, Jackson, TN 38301 | 2015-01-15 |
| 1659797702 | Worthy Walker Arrington | Nurse Practitioner | 720 West Forest Avenue, Jackson, TN 38301 | 2014-03-13 |
| 1669717302 | Lift Wellness Inc | General Practice | 101 Jackson Walk Plaza, Jackson, TN 38301 | 2012-12-06 |
| Find all providers in zip 38301 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215556048 | Hannah Roberts Badon | Internal Medicine | 2450 Wild Valley Dr, Jackson, MS 39211-6224 | 2020-04-12 |
| 1649809476 | Rachel Horn Mullins | Internal Medicine | 5379 Fairway St, Jackson, MS 39211-4251 | 2020-04-03 |
| 1861800666 | Michigan Continuum Care Pllc | Internal Medicine | 1310 Greenwood Ave., Jackson, MI 49203 | 2014-07-25 |
| 1356605752 | Jeremy Taylor | Internal Medicine | 971 Lakeland Dr Ste 450, Jackson, MS 39216-4615 | 2012-06-29 |
| 1134416019 | Zubair Khan | Internal Medicine | 3291 Creekwood Cir, Jackson, WI 53037-8927 | 2011-06-29 |
| 1801181466 | Anne Marie Shute | Internal Medicine | 7 Windwood Dr, Jackson, TN 38305-8835 | 2011-06-12 |
| 1487945648 | Howard Carroll Friday | Internal Medicine | 4019 Old Canton Rd., Jackson, MS 39216 | 2011-04-22 |
| 1801195003 | Mahir H Alsalman | Internal Medicine | 3100 Cooper St, Jackson, MI 49201-7545 | 2011-03-28 |
| 1912138967 | Tatum Medical Clinic | Internal Medicine | 5903 Ridgewood Rd Ste 330, Jackson, MS 39211-3702 | 2009-08-06 |
| 1306089040 | Hussein Othman | Internal Medicine | 205 Page Ave Ste B, Jackson, MI 49201-2462 | 2009-04-10 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.