Provider Demographics
NPI:1699758771
Name:OWEN CLINIC, P. C.
Entity type:Organization
Organization Name:OWEN CLINIC, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:W
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:901-383-8232
Mailing Address - Street 1:3980 NEW COVINGTON PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2500
Mailing Address - Country:US
Mailing Address - Phone:901-383-8232
Mailing Address - Fax:901-383-8277
Practice Address - Street 1:3980 NEW COVINGTON PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2500
Practice Address - Country:US
Practice Address - Phone:901-383-8232
Practice Address - Fax:901-383-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17915208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4077526OtherBC/BS
TN3723720Medicaid
TN3723720Medicare ID - Type Unspecified