Healthcare Provider Details

I. General information

NPI: 1407202104
Provider Name (Legal Business Name): METHODIST LEBONHEUR HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7691 POPLAR AVE
GERMANTOWN TN
38138-3904
US

IV. Provider business mailing address

3273 POWERS RD
MEMPHIS TN
38128-3443
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTY CARR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 901-516-6000