Provider Demographics
NPI:1104028737
Name:MESTEMACHER CLINIC FOR WOMEN, PLLC
Entity Type:Organization
Organization Name:MESTEMACHER CLINIC FOR WOMEN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-373-8949
Mailing Address - Street 1:7918 WOLF RIVER BLVD.
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1725
Mailing Address - Country:US
Mailing Address - Phone:901-624-4444
Mailing Address - Fax:901-202-4920
Practice Address - Street 1:7918 WOLF RIVER BLVD.
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1725
Practice Address - Country:US
Practice Address - Phone:901-624-4444
Practice Address - Fax:901-202-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDQ3581OtherRAILROAD MEDICARE
TN38163582Medicare PIN