Provider Demographics
NPI:1194839241
Name:METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
Entity Type:Organization
Organization Name:METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-516-1400
Mailing Address - Street 1:PO BOX 1000 DEPT 38
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-516-1400
Mailing Address - Fax:901-380-8081
Practice Address - Street 1:8045 CLUB PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5977
Practice Address - Country:US
Practice Address - Phone:901-758-6035
Practice Address - Fax:901-758-6029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-18
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3720605Medicare PIN