Provider Demographics
NPI:1659745354
Name:MEMPHIS HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:MEMPHIS HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRESS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:901-261-2000
Mailing Address - Street 1:360 E H CRUMP BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126-6527
Mailing Address - Country:US
Mailing Address - Phone:901-262-2025
Mailing Address - Fax:901-946-9262
Practice Address - Street 1:4593 ELVIS PRESLEY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-1511
Practice Address - Country:US
Practice Address - Phone:901-261-2000
Practice Address - Fax:901-946-9262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMPHIS HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-18
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3703728Medicare PIN