Provider Demographics
NPI:1366979668
Name:MED CLINIC OF MEMPHIS
Entity type:Organization
Organization Name:MED CLINIC OF MEMPHIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-469-5011
Mailing Address - Street 1:5821 SOUTHWEST FWY STE 550
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7531
Mailing Address - Country:US
Mailing Address - Phone:901-708-2211
Mailing Address - Fax:
Practice Address - Street 1:5084 OLD SUMMER RD STE A
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4403
Practice Address - Country:US
Practice Address - Phone:901-531-8264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty