Provider Demographics
NPI:1669518221
Name:MEMPHIS CLINICAL LABORATORY INC
Entity type:Organization
Organization Name:MEMPHIS CLINICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-727-5600
Mailing Address - Street 1:4088 BARTON DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-5821
Mailing Address - Country:US
Mailing Address - Phone:573-727-5600
Mailing Address - Fax:
Practice Address - Street 1:4088 BARTON DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-5821
Practice Address - Country:US
Practice Address - Phone:901-346-1633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0037259OtherBLUE CROSS ON TENNESSE
TN3400852Medicare ID - Type Unspecified