Healthcare Provider Details

I. General information

NPI: 1326670555
Provider Name (Legal Business Name): EAST MEMPHIS URGENT MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 POPLAR AVE STE 106
MEMPHIS TN
38119-4878
US

IV. Provider business mailing address

6515 POPLAR AVE STE 106
MEMPHIS TN
38119-4878
US

V. Phone/Fax

Practice location:
  • Phone: 901-792-0700
  • Fax:
Mailing address:
  • Phone: 901-762-0700
  • Fax: 901-779-3849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DALE W NORRIS
Title or Position: OWNER
Credential: MD
Phone: 901-762-0700