Healthcare Provider Details

I. General information

NPI: 1538366471
Provider Name (Legal Business Name): MEMPHIS REGIONAL PLANNED PARENTHOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 UNION AVE SUITE 300
MEMPHIS TN
38104-3627
US

IV. Provider business mailing address

11782 MCAULEY ST
ARLINGTON TN
38002-3889
US

V. Phone/Fax

Practice location:
  • Phone: 901-725-1717
  • Fax: 901-274-4790
Mailing address:
  • Phone: 901-496-7806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number5816
License Number StateTN

VIII. Authorized Official

Name: DR. MICHAEL STACK
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 901-725-1717