Provider Demographics
NPI:1679905251
Name:CO-MED HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:CO-MED HEALTH CARE SERVICES
Other - Org Name:CO-MED HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYQUALA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BUFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-590-6662
Mailing Address - Street 1:6095 APPLE TREE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-8600
Mailing Address - Country:US
Mailing Address - Phone:901-684-0099
Mailing Address - Fax:901-684-0098
Practice Address - Street 1:6095 APPLE TREE DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-8600
Practice Address - Country:US
Practice Address - Phone:901-684-0099
Practice Address - Fax:901-684-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251E00000X
MS251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05684013Medicaid
TN4267417Medicaid