Healthcare Provider Details

I. General information

NPI: 1124326327
Provider Name (Legal Business Name): MEMPHIS HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E EH CRUMP BLVD
MEMPHIS TN
38126-5310
US

IV. Provider business mailing address

360 E EH CRUMP BLVD
MEMPHIS TN
38126-5310
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-2002
  • Fax: 901-946-9262
Mailing address:
  • Phone: 901-261-2000
  • Fax: 901-946-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARILYN BURRESS
Title or Position: CEO
Credential:
Phone: 901-261-2012