1770649667 NPI number — HEALTH CARE CLINIC OF TENNESSEE, LLC

Table of content: (NPI 1770649667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770649667 NPI number — HEALTH CARE CLINIC OF TENNESSEE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH CARE CLINIC OF TENNESSEE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770649667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 N HAYDEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELZONI
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39038-3639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-247-1254
Provider Business Mailing Address Fax Number:
662-247-4924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3960 KNIGHT ARNOLD RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38118-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-345-5853
Provider Business Practice Location Address Fax Number:
901-346-9588
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
CLARA
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
662-247-1254

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com