Provider Demographics
NPI:1194062307
Name:INJURY MEDICAL CENTER OF MEMPHIS
Entity type:Organization
Organization Name:INJURY MEDICAL CENTER OF MEMPHIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-377-2334
Mailing Address - Street 1:2832 COLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-5815
Mailing Address - Country:US
Mailing Address - Phone:901-377-2334
Mailing Address - Fax:901-377-0912
Practice Address - Street 1:2832 COLEMAN RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5815
Practice Address - Country:US
Practice Address - Phone:901-377-2334
Practice Address - Fax:901-377-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization