Provider Demographics
NPI:1336643121
Name:UT MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:UT MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-866-8105
Mailing Address - Street 1:DEPT #93
Mailing Address - Street 2:PO BOX 1000
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0093
Mailing Address - Country:US
Mailing Address - Phone:901-866-8205
Mailing Address - Fax:901-302-2120
Practice Address - Street 1:1068 CRESTHAVEN RD STE 110
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0845
Practice Address - Country:US
Practice Address - Phone:901-767-5620
Practice Address - Fax:901-763-4326
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UT MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-19
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty