Provider Demographics
NPI:1427370600
Name:MEMPHIS CENTER FOR REPRODUCTIVE HEALTH
Entity Type:Organization
Organization Name:MEMPHIS CENTER FOR REPRODUCTIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-274-3550
Mailing Address - Street 1:1203 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7241
Mailing Address - Country:US
Mailing Address - Phone:901-274-3550
Mailing Address - Fax:901-274-3551
Practice Address - Street 1:1203 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7241
Practice Address - Country:US
Practice Address - Phone:901-274-3550
Practice Address - Fax:901-274-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000000010OtherLICENSE NUMBER
TN1522070Medicaid