Provider Demographics
NPI:1407807654
Name:FAMILY DOCTORS-DOCTORES DE FAMILIA, PLC
Entity Type:Organization
Organization Name:FAMILY DOCTORS-DOCTORES DE FAMILIA, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTEWADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-377-6805
Mailing Address - Street 1:3860 NEW COVINGTON PIKE
Mailing Address - Street 2:SUITE101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2506
Mailing Address - Country:US
Mailing Address - Phone:901-377-6805
Mailing Address - Fax:901-377-6806
Practice Address - Street 1:3860 NEW COVINGTON PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2506
Practice Address - Country:US
Practice Address - Phone:901-377-6805
Practice Address - Fax:901-377-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000040121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731181Medicaid
TN3731181Medicaid
TNH61027Medicare UPIN
TN3731181Medicare ID - Type Unspecified