Healthcare Provider Details

I. General information

NPI: 1154861219
Provider Name (Legal Business Name): UT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST NEONATAL INTENSIVE CARE UNIT
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

853 JEFFERSON AVE # ROUTE206
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 901-289-5437
  • Fax:
Mailing address:
  • Phone: 901-448-6728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. ALLISON ELPHINGSTONE
Title or Position: DIRECTOR OF OPERATIONS
Credential: MBA
Phone: 901-448-6728