Provider Demographics
NPI:1023057437
Name:PEABODY FAMILY CARE, PC
Entity type:Organization
Organization Name:PEABODY FAMILY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
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:PO BOX 1000 DEPT 297
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-725-0648
Mailing Address - Fax:901-725-1037
Practice Address - Street 1:1325 EASTMORELAND AVENUE
Practice Address - Street 2:SUITE 150
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-725-0648
Practice Address - Fax:901-725-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015606Medicaid
TN3723978Medicaid
CG9962OtherRAILROAD MEDICARE
AR8P078OtherBCBS AR-GROUP#
TN3723978Medicare PIN