Healthcare Provider Details

I. General information

NPI: 1861273823
Provider Name (Legal Business Name): METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E PARKWAY S
MEMPHIS TN
38104-5519
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 901-321-3160
  • Fax:
Mailing address:
  • Phone: 901-516-1400
  • Fax: 901-516-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. EUGENE K CASHMAN III
Title or Position: PRESIDENT
Credential:
Phone: 901-516-1434