Healthcare Provider Details

I. General information

NPI: 1558365890
Provider Name (Legal Business Name): METHODIST HEALTHCARE - MEMPHIS HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

1211 UNION AVE STE 700
MEMPHIS TN
38104-6600
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-7000
  • Fax: 901-516-0699
Mailing address:
  • Phone: 901-516-0753
  • Fax: 901-516-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number0000000109
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0000000109
License Number StateTN

VIII. Authorized Official

Name: CHARLES LANE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 901-516-0962