Provider Demographics
NPI:1124392584
Name:THE BELLEVUE CLINIC, PC
Entity Type:Organization
Organization Name:THE BELLEVUE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGLIARULO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-729-2708
Mailing Address - Street 1:333 S BELLEVUE BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3530
Mailing Address - Country:US
Mailing Address - Phone:901-729-2708
Mailing Address - Fax:901-729-2720
Practice Address - Street 1:333 S BELLEVUE BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3530
Practice Address - Country:US
Practice Address - Phone:901-729-2708
Practice Address - Fax:901-729-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty