Provider Demographics
NPI:1073514055
Name:MEMPHIS AND SHELBY COUNTY HEALTH DEPT.
Entity Type:Organization
Organization Name:MEMPHIS AND SHELBY COUNTY HEALTH DEPT.
Other - Org Name:SHELBY COUNTY GOVERNMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-272-0387
Mailing Address - Street 1:877 JEFFERSON AVE
Mailing Address - Street 2:5TH FLOOR ADAMS PAVILION
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:901-272-0387
Mailing Address - Fax:901-272-0292
Practice Address - Street 1:1064 BREEDLOVE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-2805
Practice Address - Country:US
Practice Address - Phone:901-515-5400
Practice Address - Fax:901-526-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36735207Q00000X
TN26170207R00000X
TN20023208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3385191Medicare ID - Type Unspecified
TN3385190Medicare ID - Type Unspecified
TN3385199Medicare ID - Type Unspecified
TN3385197Medicare ID - Type Unspecified
TN3385198Medicare ID - Type Unspecified
TN3385196Medicare ID - Type Unspecified