Healthcare Provider Details

I. General information

NPI: 1952704801
Provider Name (Legal Business Name): COMPLETE HEDALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 MADISON AVE.STE 401 COMPLETE HEALTH CARE CENTER
MEMPHIS TN
38104
US

IV. Provider business mailing address

1750 MADISON AVE STE 401
MEMPHIS TN
38104-6428
US

V. Phone/Fax

Practice location:
  • Phone: 901-276-2357
  • Fax: 901-398-4768
Mailing address:
  • Phone: 901-276-2357
  • Fax: 901-276-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number035097
License Number StateTN

VIII. Authorized Official

Name: DR. RALPH TAYLOR
Title or Position: MEDICAL DIRECTOR
Credential: MEDICAL DOCTOR
Phone: 901-276-2357