1477846954 NPI number — MEMORIAL HEALTH PARTNERS FOUNDATION, INC

Table of content: (NPI 1477846954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477846954 NPI number — MEMORIAL HEALTH PARTNERS FOUNDATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL HEALTH PARTNERS FOUNDATION, INC
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:
CHI MEMORIAL FAMILY PRACTICE ASSOCIATES - SPRING CITY
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:
1477846954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 CLINTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37381-4010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-365-2171
Provider Business Mailing Address Fax Number:
423-365-5456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 CLINTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37381-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-365-2171
Provider Business Practice Location Address Fax Number:
423-365-5456
Provider Enumeration Date:
05/17/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SUTTON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-495-8659

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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