1184765950 NPI number — MR. TONY MCKELVY TERRY BS

Table of content: MR. TONY MCKELVY TERRY BS (NPI 1184765950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184765950 NPI number — MR. TONY MCKELVY TERRY BS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERRY
Provider First Name:
TONY
Provider Middle Name:
MCKELVY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BS
Provider Gender Code:
M

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:
1184765950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2772 MAGGIE WOODS PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38002-6115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-379-9984
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3810 WINCHESTER RD
Provider Second Line Business Practice Location Address:
SOUTHEAST MENTAL HEALTH CENTER, INC.
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38118-6045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-369-1420
Provider Business Practice Location Address Fax Number:
901-369-1433
Provider Enumeration Date:
02/12/2007

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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