MEDICARE: METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center
2	261QC1800X	Corporate Health Clinic/Center

General Provider Information

NPI Number	:	1699941195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES

Provider Business Mailing Address
First Line	:	6400 SHELBY VIEW DR
Second Line	:	SUITE 101
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7659
Country	:	US
Telephone Number	:	901-516-1489
Fax Number	:	901-380-8081

Provider Business Practice Location Address
First Line	:	6400 SHELBY VIEW DR
Second Line	:	SUITE 101
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7659
Country	:	US
Telephone Number	:	901-516-1489
Fax Number	:	901-380-8081

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JULOY RAYMER
Credential	:
Telephone Number	:	901-516-1476

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	06/05/2008

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Practice Location Address:

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MEMPHIS, TN
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Practice Fax: 901-380-8081

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