Provider Demographics
NPI:1487003950
Name:FAMILY MEDIC PRIMARY HEALTHCARE INC
Entity Type:Organization
Organization Name:FAMILY MEDIC PRIMARY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAELANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:901-820-4445
Mailing Address - Street 1:PO BOX 181262
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38181-1262
Mailing Address - Country:US
Mailing Address - Phone:901-820-4445
Mailing Address - Fax:901-416-2888
Practice Address - Street 1:4395 STAGE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5708
Practice Address - Country:US
Practice Address - Phone:901-820-4446
Practice Address - Fax:901-416-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care