Healthcare Provider Details

I. General information

NPI: 1699758771
Provider Name (Legal Business Name): OWEN CLINIC, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 NEW COVINGTON PIKE SUITE 101
MEMPHIS TN
38128-2500
US

IV. Provider business mailing address

3980 NEW COVINGTON PIKE SUITE 101
MEMPHIS TN
38128-2500
US

V. Phone/Fax

Practice location:
  • Phone: 901-383-8232
  • Fax: 901-383-8277
Mailing address:
  • Phone: 901-383-8232
  • Fax: 901-383-8277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD17915
License Number StateTN

VIII. Authorized Official

Name: DR. EDMOND W. OWEN JR.
Title or Position: OWNER PRESIDENT
Credential: M.D.
Phone: 901-383-8232