DataLabs

datalabs.health made in the usa

Contact us Sign in | Documentation |

divider

Medicare/Medicaid Verification Programs divider

divider

Medicare Verification Program divider

divider

1780676650

NPI Code Detail

MEDICARE: UT MEDICAL GROUP INC

MEDICARE: UT MEDICAL GROUP INC

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	103TH0004X	Health Psychologist
2	207N00000X	Dermatology Physician
3	207Q00000X	Family Medicine Physician
4	207R00000X	Internal Medicine Physician
5	207V00000X	Obstetrics & Gynecology Physician
6	207W00000X	Ophthalmology Physician
7	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician
8	2080N0001X	Neonatal-Perinatal Medicine Physician
9	2084N0400X	Neurology Physician
10	2084P0800X	Psychiatry Physician
11	2084P0802X	Addiction Psychiatry Physician
12	208600000X	Surgery Physician
13	2086S0122X	Plastic and Reconstructive Surgery Physician
14	363A00000X	Physician Assistant
15	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780676650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UT MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	1068 CRESTHAVEN RD STE 300
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-0809
Country	:	US
Telephone Number	:	901-866-8864
Fax Number	:

Provider Business Practice Location Address
First Line	:	1068 CRESTHAVEN RD STE 300
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-0809
Country	:	US
Telephone Number	:	901-866-8864
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	COURTNEY LOVE
Credential	:
Telephone Number	:	901-866-8105

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	01/23/2025

Similar Medicare Providers

1750236048 — MS. KATHRYN YOUNGER MSN, APRN, NNP-BC
Practice Location Address:

1068 CRESTHAVEN RD STE 300
MEMPHIS, TN
38119-0809

Practice Phone: 901-866-8748
Practice Fax:

1003874801 — DR. PEDRO VELASQUEZ MD
Practice Location Address:

1068 CRESTHAVEN RD STE 300
MEMPHIS, TN
38119-0809

Practice Phone: 901-683-0024
Practice Fax: 901-683-0086

1598018806 — DAR SALUD CARE PLLC
Practice Location Address:

1068 CRESTHAVEN RD STE 300
MEMPHIS, TN
38119-0809

Practice Phone: 901-683-0024
Practice Fax: 901-683-0086

1740657162 — JESSICA SEAY PA
Practice Location Address:

1068 CRESTHAVEN RD STE 300
MEMPHIS, TN
38119-0809

Practice Phone: 901-683-0024
Practice Fax: 901-683-0086

1811415888 — MARTHA ROJO
Practice Location Address:

1068 CRESTHAVEN RD STE 300
MEMPHIS, TN
38119-0809

Practice Phone: 901-683-0024
Practice Fax:

1346915543 — KATHERINE SPEER PHARMD
Practice Location Address:

1068 CRESTHAVEN RD STE 300
MEMPHIS, TN
38119-0809

Practice Phone: 901-683-0024
Practice Fax:

Directions to “UT MEDICAL GROUP INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.