Provider Demographics
NPI:1164511515
Name:LUNCEFORD FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:LUNCEFORD FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUNCEFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-791-9909
Mailing Address - Street 1:1920 KIRBY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3610
Mailing Address - Country:US
Mailing Address - Phone:901-751-9909
Mailing Address - Fax:901-751-0455
Practice Address - Street 1:1920 KIRBY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3610
Practice Address - Country:US
Practice Address - Phone:901-751-9909
Practice Address - Fax:901-751-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377587Medicare ID - Type Unspecified