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General NPI Number Information
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NPI Number | 1316011679
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Entity Type | Organization
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Legal Business Name | STF MEDICAL & MANAGEMENT GROUP INC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 1049 CRESTHAVEN RD
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City | MEMPHIS
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State | TN
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Zip | 38119-3833
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Country | US
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Telephone | 901-761-9798
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Fax | 901-761-9799
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Provider Business Mailing Address
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Address Line | 1049 CRESTHAVEN RD
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City | MEMPHIS
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State | TN
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Zip | 38119-3833
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Country | US
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Telephone | 901-761-9798
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Fax | 901-761-9799
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR OMOTAYO OMOTUNDE
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Credential |
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Telephone | 901-937-7641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0000000912
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License Number State | TN
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