1992901128 NPI number — LOCUM TENENS HEALTHCARE

Table of content: (NPI 1992901128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992901128 NPI number — LOCUM TENENS HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOCUM TENENS HEALTHCARE
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:
1992901128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2156 N HIGHLAND AVE # 282
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38305-4915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-367-1116
Provider Business Mailing Address Fax Number:
901-367-1120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3145 HICKORY HILL RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38115-2533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-367-1116
Provider Business Practice Location Address Fax Number:
901-367-1120
Provider Enumeration Date:
06/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOUGLAS
Authorized Official First Name:
KELVIN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
901-367-1116

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MD0000026349 , 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: 1992901128 . This is a "NPI FOR MEMPHIS OFFICE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1982643482 . This is a "NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".