Provider Demographics
NPI:1558530881
Name:TIPTON COUNTY INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:TIPTON COUNTY INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:TEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-821-0338
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:TN
Mailing Address - Zip Code:38011-0535
Mailing Address - Country:US
Mailing Address - Phone:901-821-0338
Mailing Address - Fax:
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-821-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30013201Medicare PIN