Provider Demographics
NPI:1710067020
Name:MEMPHIS & SHELBY COUNTY PED. GROUP
Entity Type:Organization
Organization Name:MEMPHIS & SHELBY COUNTY PED. GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-396-8366
Mailing Address - Street 1:1444 E SHELBY DR
Mailing Address - Street 2:SUITE 317
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7260
Mailing Address - Country:US
Mailing Address - Phone:901-396-8281
Mailing Address - Fax:
Practice Address - Street 1:1444 E SHELBY DR
Practice Address - Street 2:SUITE 317
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7260
Practice Address - Country:US
Practice Address - Phone:901-396-8281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty