HEMOPHILIA PREFERRED CARE OF MEMPHIS INC

Provider Demographics

• NPI: 1750533816
• Name: HEMOPHILIA PREFERRED CARE OF MEMPHIS INC
• Entity type: Organization
• Organization Name: HEMOPHILIA PREFERRED CARE OF MEMPHIS INC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: DIRECTOR OF CONTRACTS AND CREDENTIA
• Authorized Official - First Name: KATHLEEN
• Authorized Official - Last Name: RICHMAN
• Authorized Official - Phone: 800-757-9192
• Mailing Address - Street 1: 6423 SHELBY VIEW DR STE 104
• Mailing Address - City: MEMPHIS
• Mailing Address - State: TN
• Mailing Address - Zip Code: 38134-7614
• Mailing Address - Country: US
• Mailing Address - Phone: 800-757-9192
• Mailing Address - Fax: 855-813-0583
• Practice Address - Street 1: 6423 SHELBY VIEW DR STE 104
• Practice Address - City: MEMPHIS
• Practice Address - State: TN
• Practice Address - Zip Code: 38134
• Practice Address - Country: US
• Practice Address - Phone: 800-757-9192
• Practice Address - Fax: 855-813-0583
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2008-10-21
• Last Update Date: 2024-03-21

Provider Licenses

State	License ID	Taxonomies
		333600000X, 3336H0001X, 332B00000X, 3336M0002X, 3336S0011X
TN	4559	3336C0003X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy
No	333600000X	Suppliers	Pharmacy
No	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	3336M0002X	Suppliers	Pharmacy	Mail Order Pharmacy
No	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MO	1750533816	Medicaid
AR	180365407	Medicaid
PA	1041917270001	Medicaid
OK	200530030A	Medicaid
TN	1533122	Medicaid
MS	09928011	Medicaid
AR	181916741	Medicaid
MO	606504009	Medicaid
VA	1750533816	Medicaid
	2117653	Other	PK
MD	423097300	Medicaid
DC	94005600	Medicaid
TN	1750533816	Medicaid
KY	7100116400	Medicaid
SC	721231	Medicaid