Provider Demographics
NPI:1558546655
Name:MEMPHIS WOMEN'S CONSULTING,PLLC
Entity Type:Organization
Organization Name:MEMPHIS WOMEN'S CONSULTING,PLLC
Other - Org Name:MEMPHIS WOMEN'S CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-757-0229
Mailing Address - Street 1:7655 POPLAR AVE
Mailing Address - Street 2:BUILDING A SUITE 130
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3957
Mailing Address - Country:US
Mailing Address - Phone:901-757-0229
Mailing Address - Fax:
Practice Address - Street 1:7655 POPLAR AVE
Practice Address - Street 2:BUILDING A SUITE 130
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3957
Practice Address - Country:US
Practice Address - Phone:901-757-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000015010174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3726929Medicaid
TN3726929Medicare PIN
TN3006681Medicare PIN
TNA97135Medicare UPIN