Provider Demographics
NPI:1255665238
Name:UNIVERSITY OF MEMPHIS
Entity Type:Organization
Organization Name:UNIVERSITY OF MEMPHIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CAPOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-678-2228
Mailing Address - Street 1:200 HUDSON HEALTH CTR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38152-3320
Mailing Address - Country:US
Mailing Address - Phone:901-678-2287
Mailing Address - Fax:901-678-3124
Practice Address - Street 1:200 HUDSON HEALTH CTR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-3320
Practice Address - Country:US
Practice Address - Phone:901-678-2287
Practice Address - Fax:901-678-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health