Provider Demographics
NPI:1962661991
Name:METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
Entity Type:Organization
Organization Name:METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES
Other - Org Name:METHODIST HEALTHCARE SLEEP DISORDERS CENTER-DESOTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-516-1724
Mailing Address - Street 1:5480 GOODMAN RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7902
Mailing Address - Country:US
Mailing Address - Phone:901-516-1489
Mailing Address - Fax:901-380-8081
Practice Address - Street 1:6400 SHELBY VIEW DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7659
Practice Address - Country:US
Practice Address - Phone:901-516-1489
Practice Address - Fax:901-380-8081
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHODIST LEBONHEUR HEATLHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic