Healthcare Provider Details

I. General information

NPI: 1922375633
Provider Name (Legal Business Name): SHELBY COUNTY HEALTH CARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2574 FRAYSER BLVD
MEMPHIS TN
38127-5829
US

IV. Provider business mailing address

877 JEFFERSON AVE 5TH FLOOR ADAMS PAVILION
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 901-515-5300
  • Fax: 901-515-5390
Mailing address:
  • Phone: 901-515-4529
  • Fax: 901-515-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SUMTER
Title or Position: COO/CIO/VP
Credential: PHD
Phone: 901-545-6763