Provider Demographics
NPI:1316040447
Name:MEMPHIS HEALTH CENTER, INC
Entity Type:Organization
Organization Name:MEMPHIS HEALTH CENTER, INC
Other - Org Name:MEMPHIS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:901-261-2081
Mailing Address - Street 1:360 E H CRUMP BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126
Mailing Address - Country:US
Mailing Address - Phone:901-261-2046
Mailing Address - Fax:901-946-9262
Practice Address - Street 1:360 E H CRUMP BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126
Practice Address - Country:US
Practice Address - Phone:901-261-2046
Practice Address - Fax:901-946-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3063336C0002X
3336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4416269OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN4447810Medicaid