CARDIOVASCULAR CLINIC OF WEST TN PC NPI 1740480961

NPI Information

  • NPI: 1740480961
  • Provider Name: CARDIOVASCULAR CLINIC OF WEST TN PC
  • Classification: Internal Medicine - 207RC0000X
  • Specialization: Cardiovascular Disease
  • Entity Type: Organization
  • Doing Business As: CARDIOVASCULAR CLINIC OF WEST TENNESSEE P.C.
  • CLIA Number: 44D1071164
  • Address: 2968 NORTH HIGHLAND AVENUE
    JACKSON, TN
    ZIP 38305
  • Phone: (731) 256-1819

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NPI Details

CARDIOVASCULAR CLINIC OF WEST TN PC is a cardiovascular disease internal medicine in Jackson, TN. The provider is 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. CARDIOVASCULAR CLINIC OF WEST TN PC NPI is 1740480961. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Cardiovascular Clinic Of West Tennessee P.c..

The provider's business location address is:

2968 NORTH HIGHLAND AVENUE
JACKSON, TN
ZIP 38305-609
Phone: (731) 256-1819
Fax: (731) 664-4330

The provider's authorized official is Adeyinka Adeboryo Agbetoyin .
The authorized official title is Cardiologist and has the following contact phone number (731) 256-1819.

The CLIA number assigned to this NPI record is 44D1071164 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 7/25/2007 and was last updated on 12/10/2010.

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
1207RC0000XInternal MedicineCardiovascular Disease36918TENNESSEEYes

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 Other Provider Identifier Issuer
11501077MEDICAIDTENNESSEE
24160707OTHERTENNESSEEBCBS
338809212MEDICARE PIN
4G76663MEDICARE UPIN

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: 3/30/2025

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