Provider Demographics
NPI:1134559073
Name:THE SAPPHIRE GROUP INC
Entity type:Organization
Organization Name:THE SAPPHIRE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENDERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBORN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:901-300-6451
Mailing Address - Street 1:4466 ELVIS PRESLEY BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7180
Mailing Address - Country:US
Mailing Address - Phone:901-300-6451
Mailing Address - Fax:855-647-3546
Practice Address - Street 1:4466 ELVIS PRESLEY BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7180
Practice Address - Country:US
Practice Address - Phone:901-300-6451
Practice Address - Fax:855-647-3546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44D2067576291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1730519711Medicaid