THE CARDIOVASCULAR CLINIC OF WEST TENNESSEE,P.C. (NPI# 1013112457) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013112457 |
| Entity Type | Organization |
| Organization Name | THE CARDIOVASCULAR CLINIC OF WEST TENNESSEE,P.C. |
| Other Organization Name | WEST TENNESSEE CARDIOVASCULAR CLINIC |
| Practice Address |
162 Murray Guard Dr Suite A Jackson TN 38305-3609 |
| Mailing Address |
38 Dovecrest Cv Jackson TN 38305-6908 |
| Practice Telephone | 7312561819 |
| Practice Fax Number | 7316644330 |
| Mailing Telephone | 7312561819 |
| Mailing Fax Number | 7316644330 |
| Enumeration Date | 2007-06-17 |
| Last Update Date | 2007-08-01 |
| Authorized Official Name | DR. ADEYINKA ADEBAYO AGBETOYIN (PRESIDENT) |
| Authorized Official Telephone | 7312561819 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
36918 | TN | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WEST TENNESSEE CARDIOVASCULAR CLINIC | Doing Business As Name - Organization |
| Street Address |
162 MURRAY GUARD DR SUITE A |
| City | JACKSON |
| State | TN |
| Zip Code | 38305-3609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619386877 | Preventagenix LLC | Nurse Practitioner | 162 Murray Guard Dr, Suite B, Jackson, TN 38305-3609 | 2014-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427656818 | Kimaya Jelks | Specialist | 1869 45 Hwy Bypass, Suite 2b, Jackson, TN 38305 | 2020-10-16 |
| 1821600578 | Maame Obeng | Pharmacist | 3144 North Highland Avenue, Jackson, TN 38305 | 2020-08-22 |
| 1700361904 | James Cowie | Psychologist | 156c West University Pkwy, Jackson, TN 38305 | 2018-10-03 |
| 1700372109 | Chad Zawacki | Physician Assistant | 147 North Star Drive, Jackson, TN 38305 | 2018-07-09 |
| 1104323070 | Golden Years Adult Day Care | Clinic/Center | 155 Carriage Dr Suite A, Jackson, TN 38305 | 2018-04-09 |
| 1245754563 | Tanika Annette Gillard | Massage Therapist | 4 Hampton Ln, Jackson, TN 38305 | 2017-07-28 |
| 1316488117 | Lakisha T Ingram | Counselor | 168 Greencastle Dr, Jackson, TN 38305 | 2017-03-13 |
| 1619421567 | D & L Wellness Inc | Community/Behavioral Health | 154 Carriage House Dr., Jackson, TN 38305 | 2016-08-09 |
| 1649637638 | Advance Choice Home Care LLC | In Home Supportive Care | 1028 Ashport Rd., Jackson, TN 38305 | 2016-01-21 |
| 1942666151 | Neurohealth Solutions Inc. | Clinic/Center | 174 Murray Guard Dr. Suite E, Jackson, TN 38305 | 2016-01-05 |
| Find all providers in zip 38305 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://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 |
|---|---|---|---|---|
| 1053935437 | Cvc Pllc | Internal Medicine | 22 Deepwood Dr, Jackson, TN 38305-9679 | 2020-06-02 |
| 1912143991 | Theophilus James Humphreys | Internal Medicine | 164 W University Pkwy Ste A, Jackson, TN 38305-1621 | 2008-12-23 |
| 1548423114 | Olurotimi Badero | Internal Medicine | 5240 Robinson Rd, Jackson, MS 39204-4134 | 2008-07-03 |
| 1740480961 | Cardiovascular Clinic of West Tn PC | Internal Medicine | 2968 North Highland Avenue, Jackson, TN 38305-3609 | 2007-07-25 |
| 1497829550 | Shawn A Baldwin | Internal Medicine | 27a Medical Center Dr, Jackson, TN 38301-3949 | 2006-11-20 |
| 1083715254 | Kenny K. Charn | Internal Medicine | 201 Clinton Rd, Suite 105, Jackson, CA 95642-2648 | 2006-09-26 |
| 1861590457 | Sandra Speckels Mccearley | Internal Medicine | 970 Lakeland Dr Ste 61, Jackson, MS 39216 | 2006-09-20 |
| 1063425734 | Mabbu Jayakumar | Internal Medicine | 168 W University Pkwy Ste C, Jackson, TN 38305-1624 | 2006-08-14 |
| 1851305429 | Jackson Cardiology Associates, P.a. | Internal Medicine | 971 Lakeland Dr Ste 850, Jackson, MS 39216-4608 | 2006-07-28 |
| 1518989003 | Hinds Cardiology Clinic Pa | Internal Medicine | 1832 Hospital Drive, Jackson, MS 39204-3410 | 2006-07-24 |
| 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.