BRUCE S. WEST NPI 1477761625

NPI Information

NPI: 1477761625
Provider Name: BRUCE S. WEST

Other Name: BRUCE S. WEST, MD

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
1340 S 18TH ST
STE. 203
FERNANDINA BEACH, FL
ZIP 32034
Phone: (904) 261-7707
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BRUCE S. WEST is a primary care clinic center in Fernandina Beach, FL. BRUCE S. WEST NPI is 1477761625. The provider is registered as an organization entity type.
The provider Other Name Is Bruce S. West, Md.

The provider's business location address is:

1340 S 18TH ST
STE. 203
FERNANDINA BEACH, FL
ZIP 32034-799
Phone: (904) 261-7707
Fax: (904) 261-8616

The provider's authorized official is Bruce S West .
The authorized official title is Owner and has the following contact phone number (904) 261-7707.

The enumeration date for this NPI number is 5/20/2007 and was last updated on 8/17/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QH0100X	Clinic/Center	Health Service	0101042844	VIRGINIA	No
2	261QP2300X	Clinic/Center	Primary Care	ME99878	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	F77792	MEDICARE UPIN	VIRGINIA
2	006734952	MEDICAID	VIRGINIA
3	113328677A	MEDICAID	GEORGIA
4	280146900	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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