Provider Demographics
NPI:1902031677
Name:STUDENTS, MOTHERS AND CONCERNED CITIZENS
Entity Type:Organization
Organization Name:STUDENTS, MOTHERS AND CONCERNED CITIZENS
Other - Org Name:MARY TAYLOR-SHELBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DELOIS
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:FOUNDER
Authorized Official - Phone:901-277-8673
Mailing Address - Street 1:PO BOX 26365
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126-0365
Mailing Address - Country:US
Mailing Address - Phone:901-785-9356
Mailing Address - Fax:
Practice Address - Street 1:3455 REBEH RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-3433
Practice Address - Country:US
Practice Address - Phone:901-785-9356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-23
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN059824279341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN172V00000XMedicaid
TN207W00000XMedicaid
TN171W00000XMedicaid
TN171M00000XMedicaid
TN193200000XOtherMULTI-SPCIALTY
TN172V00000XMedicare PIN
TN172V00000XMedicaid
TN171W00000XMedicaid