| Organization Name: | WESTLAKE PRIMARY CARE OF RUSSELL COUNTY MEDICAL GROUP |
| NPI Number: | 1023280518 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | REX A TUNGATE (CEO, ADMINISTRATOR) |
| Mailing Address: | 2465 Lakeway Drive Russell Springs |
| State: | KY US |
| Postal Code: | 42642 |
| Phone Number: | 2708583636 |
| Fax Number: | 2708583660 |
| NPI Enumeration Date: | 03/25/2008 |
| NPI Last Update Date: | 03/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | 28235 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |