Healthcare Provider Details

I. General information

NPI: 1699941195
Provider Name (Legal Business Name): METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 901-516-1489
  • Fax: 901-380-8081
Mailing address:
  • Phone: 901-516-1489
  • Fax: 901-380-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULOY RAYMER
Title or Position: DIRECTOR
Credential:
Phone: 901-516-1476