Provider Demographics
NPI:1437216694
Name:METHODIST HEALTHCARE-MEMPHIS HOSPITALS
Entity Type:Organization
Organization Name:METHODIST HEALTHCARE-MEMPHIS HOSPITALS
Other - Org Name:LE BONHEUR OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-516-0696
Mailing Address - Street 1:51 NORTH DUNLAP STREET
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105
Mailing Address - Country:US
Mailing Address - Phone:901-287-6050
Mailing Address - Fax:901-287-6027
Practice Address - Street 1:51 NORTH DUNLAP STREET
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-287-6050
Practice Address - Fax:901-287-6027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3225333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0330513Medicaid
TN4431196OtherNABP
TNBL5371137OtherDEA
TN0488760003Medicare ID - Type UnspecifiedMEDICARE