Provider Demographics
NPI:1629730411
Name:MEDICAL CARE OF TENNESSEE PLLC
Entity Type:Organization
Organization Name:MEDICAL CARE OF TENNESSEE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:DE VERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-652-1598
Mailing Address - Street 1:3175 LENOX PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4260
Mailing Address - Country:US
Mailing Address - Phone:901-652-1598
Mailing Address - Fax:
Practice Address - Street 1:3175 LENOX PARK BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4260
Practice Address - Country:US
Practice Address - Phone:901-652-1598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL CARE OF TENNESSEE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-08
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty