Provider Demographics
NPI:1154461218
Name:MIDTOWN INJURY & PHYSICAL THERAPY CENTER P.C.
Entity Type:Organization
Organization Name:MIDTOWN INJURY & PHYSICAL THERAPY CENTER P.C.
Other - Org Name:MIDTOWN INJURY & PHYSICAL THERAPY CENTER P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-726-4108
Mailing Address - Street 1:1488 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2447
Mailing Address - Country:US
Mailing Address - Phone:901-726-4110
Mailing Address - Fax:901-726-4106
Practice Address - Street 1:1488 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2447
Practice Address - Country:US
Practice Address - Phone:901-726-4110
Practice Address - Fax:901-726-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3335622Medicaid
TNH80460Medicare UPIN
TN3335622Medicaid
TN6158760001Medicare NSC
TN3731897Medicare PIN