Provider Demographics
NPI:1760641716
Name:HOUSE CALL PRACTIONERS OF TENNESSEE, LLC
Entity Type:Organization
Organization Name:HOUSE CALL PRACTIONERS OF TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH STEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP BC
Authorized Official - Phone:901-366-2220
Mailing Address - Street 1:3960 KNIGHT ARNOLD RD
Mailing Address - Street 2:103
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3035
Mailing Address - Country:US
Mailing Address - Phone:901-366-2220
Mailing Address - Fax:901-366-2100
Practice Address - Street 1:3960 KNIGHT ARNOLD RD
Practice Address - Street 2:103
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3035
Practice Address - Country:US
Practice Address - Phone:901-366-2220
Practice Address - Fax:901-366-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519130Medicaid