Provider Demographics
NPI:1053470021
Name:JAMES H SHULL MD PC
Entity Type:Organization
Organization Name:JAMES H SHULL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:SHULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-757-0655
Mailing Address - Street 1:2900 KIRBY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-757-0655
Mailing Address - Fax:901-757-1608
Practice Address - Street 1:2900 KIRBY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-757-0655
Practice Address - Fax:901-757-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17329208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0064667OtherBLUE CROSS TN
TN0064667OtherBLUE CROSS TN