Provider Demographics
NPI:1144213117
Name:SHELBY COUNTY HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:SHELBY COUNTY HEALTH CARE CORPORATION
Other - Org Name:REGIONAL ONE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-545-7676
Mailing Address - Street 1:877 JEFFERSON AVE
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:901-545-6265
Mailing Address - Fax:901-545-8194
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-6265
Practice Address - Fax:901-545-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00020421Medicaid
TN0440152Medicaid
MO010159200Medicaid
TN1OtherTLC
AR107092105Medicaid
TN0440152OtherOMNICARE
KY01620772Medicaid
TN000000118296OtherBETTER HEALTH
LA1737119Medicaid
TN9460OtherBC OF TN
GA000491004XMedicaid
AR107092105Medicaid
=========OtherUNITED HEALTHCARE
MS00020421Medicaid
TN0440152Medicaid
KY01620772Medicaid