Provider Demographics
NPI:1326670555
Name:EAST MEMPHIS URGENT MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:EAST MEMPHIS URGENT MEDICAL CLINIC PC
Other - Org Name:EAST MEMPHIS URGENT MEDCIAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:W
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-762-0700
Mailing Address - Street 1:6515 POPLAR AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4878
Mailing Address - Country:US
Mailing Address - Phone:901-762-0700
Mailing Address - Fax:901-779-3849
Practice Address - Street 1:6515 POPLAR AVE STE 106
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4878
Practice Address - Country:US
Practice Address - Phone:901-792-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty