Provider Demographics
NPI:1710203674
Name:UTHSC, MEMPHIS, TN
Entity Type:Organization
Organization Name:UTHSC, MEMPHIS, TN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCY PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-448-4795
Mailing Address - Street 1:810 WASHINGTON AVE
Mailing Address - Street 2:APARTMENT 605
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4571
Mailing Address - Country:US
Mailing Address - Phone:267-779-3813
Mailing Address - Fax:
Practice Address - Street 1:853 JEFFERSON AVE
Practice Address - Street 2:SUITE E105D2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-448-4795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen