Provider Demographics
NPI:1366863193
Name:MEMPHIS CLINICS LLC
Entity Type:Organization
Organization Name:MEMPHIS CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-724-7788
Mailing Address - Street 1:2626 S LOOP W STE 260
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2849
Mailing Address - Country:US
Mailing Address - Phone:281-724-7788
Mailing Address - Fax:713-838-9738
Practice Address - Street 1:5084 OLD SUMMER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4403
Practice Address - Country:US
Practice Address - Phone:901-244-4224
Practice Address - Fax:901-244-4221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center