Healthcare Provider Details

I. General information

NPI: 1114953635
Provider Name (Legal Business Name): TENET HEALTHSYSTEM SF-SNF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE
MEMPHIS TN
38119-5200
US

IV. Provider business mailing address

5959 PARK AVE
MEMPHIS TN
38119-5200
US

V. Phone/Fax

Practice location:
  • Phone: 901-765-3110
  • Fax: 901-765-3106
Mailing address:
  • Phone: 901-765-3110
  • Fax: 901-765-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number254
License Number StateTN

VIII. Authorized Official

Name: MR. DOUGLAS E. RABE
Title or Position: VP OF TAXATION, TENET HEALTHCARE
Credential:
Phone: 469-893-2530