Basic Information
| Provider Information | |||||||||
| NPI: | 1518034933 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST LPN INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3900 W 15TH ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750757751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725198300 | ||||||||
| FaxNumber: | 9725198337 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 W 15TH ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750757751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725198300 | ||||||||
| FaxNumber: | 9725198337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 05/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | HENDERSON | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9724018726 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 176917604 | 05 | TX | MEDICAID | 176917601 | 05 | TX | MEDICAID | 176917603 | 05 | TX | MEDICAID |