Healthcare Provider Details

I. General information

NPI: 1073923850
Provider Name (Legal Business Name): MAXINE SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 CADES CV
MEMPHIS TN
38125-5019
US

IV. Provider business mailing address

7475 CADES CV
MEMPHIS TN
38125-5019
US

V. Phone/Fax

Practice location:
  • Phone: 901-833-8156
  • Fax:
Mailing address:
  • Phone: 901-833-8156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number3988
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: