Provider Demographics
NPI:1376738906
Name:ADULT PRIMARY CARE OF MEMPHIS PC
Entity Type:Organization
Organization Name:ADULT PRIMARY CARE OF MEMPHIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:I
Authorized Official - Last Name:ABUTINEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-761-6157
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0338
Mailing Address - Country:US
Mailing Address - Phone:901-761-6157
Mailing Address - Fax:
Practice Address - Street 1:6263 POPLAR AVE
Practice Address - Street 2:SUITE 1052
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4701
Practice Address - Country:US
Practice Address - Phone:901-761-6157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4059600OtherBCBS OF TN
TN4059600OtherBCBS OF TN
TNG38647Medicare UPIN