Healthcare Provider Details

I. General information

NPI: 1548441546
Provider Name (Legal Business Name): METHODIST HEALTHCARE PRIMARY CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 NEW COVINGTON PIKE SUITE 130
MEMPHIS TN
38128-2591
US

IV. Provider business mailing address

3950 NEW COVINGTON PIKE SUITE 130
MEMPHIS TN
38128-2591
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-0843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS MCLEAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 901-516-0725