Provider Demographics
NPI:1972782670
Name:OB GYN CENTERS OF MEMPHIS,MPLLC
Entity Type:Organization
Organization Name:OB GYN CENTERS OF MEMPHIS,MPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AOM
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-396-5577
Mailing Address - Street 1:1264 WESLEY DR STE 402
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6447
Mailing Address - Country:US
Mailing Address - Phone:901-396-5577
Mailing Address - Fax:901-396-6538
Practice Address - Street 1:1264 WESLEY DR STE 402
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6447
Practice Address - Country:US
Practice Address - Phone:901-396-5577
Practice Address - Fax:901-396-6538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207V00000X207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717431Medicare PIN