Provider Demographics
NPI:1821272501
Name:METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
Entity Type:Organization
Organization Name:METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
Other - Org Name:METHODIST MINOR MEDICAL OLIVE BRANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & CEO AFFILIATED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-516-1434
Mailing Address - Street 1:PO BOX 1000 DEPT 38
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-516-1489
Mailing Address - Fax:901-380-8081
Practice Address - Street 1:7235 HACKS CROSS RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-4213
Practice Address - Country:US
Practice Address - Phone:662-893-9800
Practice Address - Fax:662-893-9827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHODIST LEBONHEUR HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-18
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02007Medicare PIN