1144213117 NPI number — SHELBY COUNTY HEALTH CARE CORPORATION

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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".
  • Identifier: 107702500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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