Healthcare Provider Details

I. General information

NPI: 1225723133
Provider Name (Legal Business Name): METHODIST HEALTHCARE - MEMPHIS HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 SHELBY OAKS CIR
MEMPHIS TN
38134-7329
US

IV. Provider business mailing address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-8168
  • Fax: 901-516-0385
Mailing address:
  • Phone: 901-516-8168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LARRY FOGARTY
Title or Position: VP OF FINANCE/REIMBURSEMENT
Credential:
Phone: 901-478-1057