Provider Demographics
NPI:1306486493
Name:BLUFF CITY MULTISPECIALTY CLINIC
Entity type:Organization
Organization Name:BLUFF CITY MULTISPECIALTY CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRYE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:901-685-8202
Mailing Address - Street 1:740 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-3004
Mailing Address - Country:US
Mailing Address - Phone:901-685-8202
Mailing Address - Fax:901-682-3525
Practice Address - Street 1:740 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-3004
Practice Address - Country:US
Practice Address - Phone:901-685-8202
Practice Address - Fax:901-682-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty