Provider Demographics
NPI:1972751154
Name:NEWSOM HEALTHCARE, INC
Entity Type:Organization
Organization Name:NEWSOM HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-756-5565
Mailing Address - Street 1:3249 W SARAZENS CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-0807
Mailing Address - Country:US
Mailing Address - Phone:901-756-5565
Mailing Address - Fax:901-756-5564
Practice Address - Street 1:2906 GOODMAN RD W
Practice Address - Street 2:SUITE 109
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1291
Practice Address - Country:US
Practice Address - Phone:662-393-8022
Practice Address - Fax:662-393-8052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-30
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07823202Medicaid
MS07823202Medicaid