Provider Demographics
NPI:1922375633
Name:SHELBY COUNTY HEALTH CARE CORP.
Entity Type:Organization
Organization Name:SHELBY COUNTY HEALTH CARE CORP.
Other - Org Name:HEALTH LOOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO/CIO/VP
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-545-6763
Mailing Address - Street 1:877 JEFFERSON AVE
Mailing Address - Street 2:5TH FLOOR ADAMS PAVILION
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:901-515-4529
Mailing Address - Fax:901-515-4599
Practice Address - Street 1:2574 FRAYSER BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-5829
Practice Address - Country:US
Practice Address - Phone:901-515-5300
Practice Address - Fax:901-515-5390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBY COUNTY HEALTH CARE CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3733557Medicare PIN