Healthcare Provider Details

I. General information

NPI: 1902279060
Provider Name (Legal Business Name): MED PLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 W POPLAR AVE
COLLIERVILLE TN
38017-2513
US

IV. Provider business mailing address

875 W POPLAR AVE
COLLIERVILLE TN
38017-2513
US

V. Phone/Fax

Practice location:
  • Phone: 901-562-3055
  • Fax:
Mailing address:
  • Phone: 901-562-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateTN

VIII. Authorized Official

Name: P GIBONEY
Title or Position: VP
Credential:
Phone: 901-562-3055