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General NPI Number Information
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NPI Number | 1639290331
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Entity Type | Organization
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Legal Business Name | METHODIST-LEBONHEUR HEALTHCARE
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 2400 POPLAR AVE SUITE 318
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City | MEMPHIS
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State | TN
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Zip | 38112-3213
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Country | US
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Telephone | 901-287-4700
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Fax | 901-287-4701
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Provider Business Mailing Address
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Address Line | 2400 POPLAR AVE SUITE 318
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City | MEMPHIS
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State | TN
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Zip | 38112-3213
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Country | US
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Telephone | 901-287-4700
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Fax | 901-287-4701
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Authorized Official
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Title or Position | DIRECTOR OF LEBONHEUR CCP
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Name | MS. SANDRA M ALLEN
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Credential | LCSW
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Telephone | 901-287-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | 1 214-037-9722
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License Number State | TN
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