MEDICARE: RODRIGUEZ BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	079487198	TN
2	174200000X	Meals Provider
3	253Z00000X	In Home Supportive Care Agency
4	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1720736127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODRIGUEZ BROWN

Provider Business Mailing Address
First Line	:	8486 FRIEDEN TRL
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-3348
Country	:	US
Telephone Number	:	901-860-1885
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 JEFFERSON AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38103-2328
Country	:	US
Telephone Number	:	901-860-1885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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Directions to “ RODRIGUEZ BROWN ” Practice Location

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