1144213117 NPI number — SHELBY COUNTY HEALTH CARE CORPORATION

Table of content: (NPI 1144213117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144213117 NPI number — SHELBY COUNTY HEALTH CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELBY COUNTY HEALTH CARE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REGIONAL ONE HEALTH
Provider Other Organization Name Type Code:
3
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:
1144213117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
877 JEFFERSON AVE
Provider Second Line Business Mailing Address:
ADMINISTRATION
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38103-2807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-545-6265
Provider Business Mailing Address Fax Number:
901-545-8194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
877 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38103-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-545-6265
Provider Business Practice Location Address Fax Number:
901-545-8194
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PROCTOR
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP/CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
901-545-7676

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , 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: 00020421 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0440152 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010159200 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1 . This is a "TLC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 107092105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0440152 . This is a "OMNICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 01620772 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000118296 . This is a "BETTER HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1737119 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9460 . This is a "BC OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000491004X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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