Provider Demographics
NPI:1518143692
Name:UNIVERSITY OF MEMPHIS
Entity Type:Organization
Organization Name:UNIVERSITY OF MEMPHIS
Other - Org Name:MID-SOUTH ACT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAVONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY-CLAYBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-678-1489
Mailing Address - Street 1:119 PATTERSON HALL
Mailing Address - Street 2:MAIN OFFICE
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38152-3510
Mailing Address - Country:US
Mailing Address - Phone:901-678-1489
Mailing Address - Fax:901-678-3215
Practice Address - Street 1:119 PATTERSON HALL
Practice Address - Street 2:MAIN OFFICE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-3510
Practice Address - Country:US
Practice Address - Phone:901-678-1489
Practice Address - Fax:901-678-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty