Healthcare Provider Details

I. General information

NPI: 1902031677
Provider Name (Legal Business Name): STUDENTS, MOTHERS AND CONCERNED CITIZENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2009
Last Update Date: 05/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 REBEH RD
MEMPHIS TN
38109-3433
US

IV. Provider business mailing address

PO BOX 26365
MEMPHIS TN
38126-0365
US

V. Phone/Fax

Practice location:
  • Phone: 901-785-9356
  • Fax:
Mailing address:
  • Phone: 901-785-9356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number059824279
License Number StateTN

VIII. Authorized Official

Name: MS. MARY DELOIS WRIGHT
Title or Position: PRESIDENT
Credential: FOUNDER
Phone: 901-277-8673