Provider Demographics
NPI:1023124393
Name:METHODIST HEALTHCARE PRIMARY CARE ASSOCIATES
Entity type:Organization
Organization Name:METHODIST HEALTHCARE PRIMARY CARE ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-448-6635
Mailing Address - Street 1:66 N PAULINE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-5101
Mailing Address - Country:US
Mailing Address - Phone:901-448-7642
Mailing Address - Fax:901-448-8015
Practice Address - Street 1:1325 EASTMORELAND AVE STE 550
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7507
Practice Address - Country:US
Practice Address - Phone:901-448-6635
Practice Address - Fax:901-448-5721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710704Medicare ID - Type UnspecifiedGROUP