1609879865 NPI number — DR. PATRICIA M FLYNN MD

Table of content: DR. PATRICIA M FLYNN MD (NPI 1609879865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609879865 NPI number — DR. PATRICIA M FLYNN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLYNN
Provider First Name:
PATRICIA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609879865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Provider Second Line Business Mailing Address:
332 N LAUDERDALE ST., MS 0515
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38105-2794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-495-3006
Provider Business Mailing Address Fax Number:
901-495-3842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Provider Second Line Business Practice Location Address:
332 N LAUDERDALE ST., MS 0515
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38105-2794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-495-3006
Provider Business Practice Location Address Fax Number:
901-495-3842
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0208X , with the licence number:  15557 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00015183 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2004422 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64795750 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6738338 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3029895 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1429651 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0533356 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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