Provider Demographics
NPI:1518982008
Name:NORTH INTERNAL MEDICINE, P. C.
Entity Type:Organization
Organization Name:NORTH INTERNAL MEDICINE, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-387-0193
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0216
Mailing Address - Country:US
Mailing Address - Phone:901-387-0193
Mailing Address - Fax:901-387-0193
Practice Address - Street 1:4901 RALEIGH COMMONS DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128
Practice Address - Country:US
Practice Address - Phone:901-387-0193
Practice Address - Fax:901-387-0796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3701490Medicare ID - Type Unspecified