Provider Demographics
NPI:1124234380
Name:FIRSTCARE MEDICAL CENTER, PC
Entity type:Organization
Organization Name:FIRSTCARE MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:OBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-772-3442
Mailing Address - Street 1:BOX 1798 DEPT 07-031
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101
Mailing Address - Country:US
Mailing Address - Phone:731-696-2142
Mailing Address - Fax:731-696-2159
Practice Address - Street 1:281-4 CLIMER LOOP ROAD
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001
Practice Address - Country:US
Practice Address - Phone:731-696-2142
Practice Address - Fax:731-696-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377799Medicaid
TN3377799Medicare ID - Type Unspecified