Healthcare Provider Details

I. General information

NPI: 1659494359
Provider Name (Legal Business Name): REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MADISON AVE SUITE 5BOL
MEMPHIS NE
38134
US

IV. Provider business mailing address

2991 WOOD THRUSH DR
MEMPHIS TN
38134-3155
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-6262
  • Fax: 901-545-7177
Mailing address:
  • Phone: 901-388-6648
  • Fax: 901-545-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0000006000
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number000006000
License Number StateTN

VIII. Authorized Official

Name: MRS. MARYE ESTHER BERNARD
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP
Phone: 901-545-6262