Provider Demographics
NPI:1043369143
Name:GETWELL COMMUNITY CLINIC, LLC
Entity Type:Organization
Organization Name:GETWELL COMMUNITY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROURKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:ARNP
Authorized Official - Phone:901-369-4900
Mailing Address - Street 1:3055 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3011
Mailing Address - Country:US
Mailing Address - Phone:901-369-4900
Mailing Address - Fax:901-365-3555
Practice Address - Street 1:3055 WATSON ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3011
Practice Address - Country:US
Practice Address - Phone:901-369-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26642207R00000X
TNAPN0000006732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3736618OtherFEDERAL MEDICARE NUMBER