| Friends For Life Corporation | |
|
806 S Cooper St Memphis TN 38104-5406 | |
| (901) 896-0739 | |
| Not Available |
| Full Name | Friends For Life Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 806 S Cooper St, Memphis, Tennessee |
| Authorized Official Name and Position | Diane Duke (CEO) |
| Authorized Official Contact | 7472307297 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Friends For Life Corporation 1548 Poplar Ave Memphis TN 38104-2432 Ph: (901) 333-8269 | Friends For Life Corporation 806 S Cooper St Memphis TN 38104-5406 Ph: (901) 896-0739 |
| NPI Number | 1285398834 |
|---|---|
| Provider Enumeration Date | 10/28/2021 |
| Last Update Date | 04/05/2024 |
| Certification Date | 04/05/2024 |
| Medicare PECOS PAC ID | 6103215934 |
|---|---|
| Medicare Enrollment ID | O20211116001564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285398834 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Shawn J Hayden |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609835909 PECOS PAC ID: 9335299189 Enrollment ID: I20090616000814 |
| Provider Name | Jessica L Vinas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528555406 PECOS PAC ID: 8022369982 Enrollment ID: I20180917001548 |
| Provider Name | Ramona Annette Lousie Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477127330 PECOS PAC ID: 3779972518 Enrollment ID: I20211116001951 |
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