Provider Demographics
NPI:1306164900
Name:MEMPHIS HAND CENTERS
Entity type:Organization
Organization Name:MEMPHIS HAND CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-661-9542
Mailing Address - Street 1:705 E POPLAR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-1828
Mailing Address - Country:US
Mailing Address - Phone:731-453-5511
Mailing Address - Fax:731-661-9533
Practice Address - Street 1:705 E POPLAR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-1828
Practice Address - Country:US
Practice Address - Phone:731-453-5511
Practice Address - Fax:731-686-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2015-01-21
Deactivation Date:2014-09-03
Deactivation Code:
Reactivation Date:2015-01-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446649Medicare PIN
TN446649Medicare UPIN