Healthcare Provider Details

I. General information

NPI: 1134552219
Provider Name (Legal Business Name): REGIONAL MED EXTENDED CARE HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 MADISON AVE 4TH FLOOR
MEMPHIS TN
38103-3409
US

IV. Provider business mailing address

890 MADISON AVE 4TH FLOOR
MEMPHIS TN
38103-3409
US

V. Phone/Fax

Practice location:
  • Phone: 901-515-3000
  • Fax:
Mailing address:
  • Phone: 901-515-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number186
License Number StateTN

VIII. Authorized Official

Name: MARK KELLY
Title or Position: ADMINISTRATOR
Credential:
Phone: 901-515-3000