Provider Demographics
NPI:1902292865
Name:FAMILY MEDICINE WEST PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE WEST PLLC
Other - Org Name:FAMILY MEDICINE WEST OF WARTBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:P
Authorized Official - Last Name:THANKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-346-5566
Mailing Address - Street 1:220 FORT SANDERS WEST BLVD
Mailing Address - Street 2:BUILDING 2, SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3398
Mailing Address - Country:US
Mailing Address - Phone:423-346-5566
Mailing Address - Fax:423-346-5631
Practice Address - Street 1:1236 KNOXVILLE HWY
Practice Address - Street 2:SUITE 500
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4200
Practice Address - Country:US
Practice Address - Phone:423-346-5566
Practice Address - Fax:423-346-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health