1366993974 NPI number — CONSOLIDATED HEALTH SERVICES OF MEMPHIS, PLLC

Table of content: (NPI 1366993974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366993974 NPI number — CONSOLIDATED HEALTH SERVICES OF MEMPHIS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSOLIDATED HEALTH SERVICES OF MEMPHIS, PLLC
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:
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:
1366993974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3315 HACKS CROSS RD
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38125-8935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-509-2232
Provider Business Mailing Address Fax Number:
901-552-3986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3315 HACKS CROSS RD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38125-8935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-509-2232
Provider Business Practice Location Address Fax Number:
901-552-3986
Provider Enumeration Date:
10/18/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LITTON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
901-509-2232

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q025422 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".