Healthcare Provider Details

I. General information

NPI: 1457557027
Provider Name (Legal Business Name): METHODIST SPECIALTY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 01/13/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 SHELBY VIEW DR STE 101
MEMPHIS TN
38134-7659
US

IV. Provider business mailing address

6400 SHELBY VIEW DR STE 101
MEMPHIS TN
38134-7659
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-1400
  • Fax: 901-516-1401
Mailing address:
  • Phone: 901-516-1400
  • Fax: 901-516-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GINA BAPTISTE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 901-516-1400