| Church Health Center | |
|
1200 Peabody Ave Memphis TN 38104-4506 | |
| (901) 272-0003 | |
| (901) 725-1435 |
| Full Name | Church Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1200 Peabody Ave, Memphis, Tennessee |
| Authorized Official Name and Position | Dan E Mungle (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 9012720003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Church Health Center Po Box 41527 Memphis TN 38174-1527 Ph: (901) 272-0003 | Church Health Center 1200 Peabody Ave Memphis TN 38104-4506 Ph: (901) 272-0003 |
| NPI Number | 1427030907 |
|---|---|
| Provider Enumeration Date | 11/18/2005 |
| Last Update Date | 03/05/2010 |
| Medicare PECOS PAC ID | 7517863392 |
|---|---|
| Medicare Enrollment ID | O20100825000655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427030907 | NPI | - | NPPES |
| 3388963 | Other | TN | TENNCARE TLC |
| 3388963 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Tennessee) | Primary |
| Provider Name | William S Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457334633 PECOS PAC ID: 0749183234 Enrollment ID: I20040130001056 |
| Provider Name | James C Fleming |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1477510857 PECOS PAC ID: 5799674628 Enrollment ID: I20040310001485 |
| Provider Name | Sharon L Thorpe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831105733 PECOS PAC ID: 8921080946 Enrollment ID: I20040603000775 |
| Provider Name | J Hays Brantley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437150315 PECOS PAC ID: 2365410057 Enrollment ID: I20040921000315 |
| Provider Name | Sheila M Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518965128 PECOS PAC ID: 7810958345 Enrollment ID: I20041019000823 |
| Provider Name | Susan F Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407870553 PECOS PAC ID: 2062440431 Enrollment ID: I20050728000138 |
| Provider Name | Jennifer Celeste Goodfred |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205878105 PECOS PAC ID: 6608879267 Enrollment ID: I20060821000382 |
| Provider Name | Veronica M Swannigan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811979693 PECOS PAC ID: 3072511344 Enrollment ID: I20061121000066 |
| Provider Name | Angela Potter Campbell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710979596 PECOS PAC ID: 6305939505 Enrollment ID: I20070904000638 |
| Provider Name | Kent Alan Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497781298 PECOS PAC ID: 7719969914 Enrollment ID: I20080311000124 |
| Provider Name | David J Richardson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962451252 PECOS PAC ID: 2668459611 Enrollment ID: I20090813000418 |
| Provider Name | Banjul L Covington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811155435 PECOS PAC ID: 6002956422 Enrollment ID: I20091216000209 |
| Provider Name | Glenn Scott Morris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942283270 PECOS PAC ID: 5294816609 Enrollment ID: I20100826000067 |
| Provider Name | Anne Lorraine Self Sullivan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114913555 PECOS PAC ID: 6800864158 Enrollment ID: I20120608000186 |
| Provider Name | Collins Walker Rainey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316265820 PECOS PAC ID: 4385880103 Enrollment ID: I20130830000507 |
| Provider Name | Aditee Kulkarni Satpute |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558523688 PECOS PAC ID: 5799951877 Enrollment ID: I20141020002116 |
| Provider Name | Stephanie L Johnson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1659825669 PECOS PAC ID: 7517245871 Enrollment ID: I20161021000449 |
| Provider Name | Tammy L Tyson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184602450 PECOS PAC ID: 8820222953 Enrollment ID: I20180723000945 |
| Provider Name | Melissa Jean Fullerton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982869855 PECOS PAC ID: 3476724584 Enrollment ID: I20190209000105 |
| Provider Name | Kirsten Jenelle Mcknight |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1831541978 PECOS PAC ID: 1254614480 Enrollment ID: I20191213000717 |
| Provider Name | Kimberly A Boone |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1376195594 PECOS PAC ID: 5890128326 Enrollment ID: I20191213001136 |
| Provider Name | Meredith M Walsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366740615 PECOS PAC ID: 2668609025 Enrollment ID: I20200325000129 |
| Provider Name | Joseph Hogue |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669886594 PECOS PAC ID: 1557665528 Enrollment ID: I20200430001777 |
| Provider Name | Michael Cacoilo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487186078 PECOS PAC ID: 7315217908 Enrollment ID: I20200915003685 |
| Provider Name | Jennifer E Anderson Connell |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1336692623 PECOS PAC ID: 6406143544 Enrollment ID: I20201029002166 |
| Provider Name | Melissa A Barnhart |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538606520 PECOS PAC ID: 7012294754 Enrollment ID: I20220823002234 |
| Provider Name | Prashanth Bhat |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710295464 PECOS PAC ID: 9234327164 Enrollment ID: I20230327000733 |
| Provider Name | Joel T Finley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245729961 PECOS PAC ID: 9133476708 Enrollment ID: I20230918002921 |
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