Provider Demographics
NPI:1750540530
Name:ACCUCARE MEDICAL
Entity type:Organization
Organization Name:ACCUCARE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RESHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKINNEY-KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-395-0075
Mailing Address - Street 1:3121 WALLINGFORD ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3931
Mailing Address - Country:US
Mailing Address - Phone:901-395-0075
Mailing Address - Fax:901-395-0072
Practice Address - Street 1:4108 S PLAZA DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6335
Practice Address - Country:US
Practice Address - Phone:901-395-0075
Practice Address - Fax:901-395-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT000356343900000X, 347C00000X
TN0000000971332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle