Provider Demographics
NPI:1447792536
Name:METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATION
Entity Type:Organization
Organization Name:METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATION
Other - Org Name:METHODIST MINOR MEDICAL CENTER - MIDTOWN
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-516-1400
Mailing Address - Street 1:6501 CITY WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3248
Mailing Address - Country:US
Mailing Address - Phone:952-653-2525
Mailing Address - Fax:
Practice Address - Street 1:1803 UNION AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3942
Practice Address - Country:US
Practice Address - Phone:901-722-3152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site