| Darsalud Community Center Inc | |
|
6063 Mount Moriah Road Ext Ste 4 Memphis TN 38115-2665 | |
| (901) 531-8800 | |
| (901) 531-8801 |
| Full Name | Darsalud Community Center Inc |
|---|---|
| Speciality | General Practice |
| Location | 6063 Mount Moriah Road Ext Ste 4, Memphis, Tennessee |
| Authorized Official Name and Position | Andrea Lajuana Ivory Fuller (BILLING AND CREDENTIALING MANAGER) |
| Authorized Official Contact | 9019225951 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Darsalud Community Center Inc 6625 Lenox Park Dr Ste 202 Memphis TN 38115-8200 Ph: (901) 922-5951 | Darsalud Community Center Inc 6063 Mount Moriah Road Ext Ste 4 Memphis TN 38115-2665 Ph: (901) 531-8800 |
| NPI Number | 1174184709 |
|---|---|
| Provider Enumeration Date | 06/25/2019 |
| Last Update Date | 06/12/2024 |
| Medicare PECOS PAC ID | 1759706567 |
|---|---|
| Medicare Enrollment ID | O20200810002957 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174184709 | NPI | - | NPPES |
| Q051384 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Pedro A Velasquez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003874801 PECOS PAC ID: 0143296467 Enrollment ID: I20040908001050 |
| Provider Name | Jennifer D Mink |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1598759359 PECOS PAC ID: 7012954688 Enrollment ID: I20050414000834 |
| Provider Name | Angie J Childers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750391116 PECOS PAC ID: 1052328887 Enrollment ID: I20060320000224 |
| Provider Name | Claudia P Neira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598866568 PECOS PAC ID: 4486748662 Enrollment ID: I20070919000244 |
| Provider Name | Tavares Kinte Williams |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1669629531 PECOS PAC ID: 1850578659 Enrollment ID: I20110603000285 |
| Provider Name | Kelly Hoy |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1437177318 PECOS PAC ID: 5092980466 Enrollment ID: I20111213000796 |
| Provider Name | Aftab A Shaikh |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1528018868 PECOS PAC ID: 2365479615 Enrollment ID: I20120731000541 |
| Provider Name | Lydia M Franklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083673792 PECOS PAC ID: 9537131958 Enrollment ID: I20131014000894 |
| Provider Name | Lefonda Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285059733 PECOS PAC ID: 5395968101 Enrollment ID: I20140523001667 |
| Provider Name | Rebecca L Goedecke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275884645 PECOS PAC ID: 8527373646 Enrollment ID: I20150819007422 |
| Provider Name | Sentorita Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295117091 PECOS PAC ID: 7517276884 Enrollment ID: I20151028000343 |
| Provider Name | Andrew C Ragin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477199354 PECOS PAC ID: 0042646937 Enrollment ID: I20200213000719 |
| Provider Name | Stephanie Nicole Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700444056 PECOS PAC ID: 9436570165 Enrollment ID: I20200604000094 |
| Provider Name | Emily Marie Jennewine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356810246 PECOS PAC ID: 8921424789 Enrollment ID: I20200811003841 |
| Provider Name | Kelsey Alexandra James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154992956 PECOS PAC ID: 9133522162 Enrollment ID: I20210728000845 |
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Jerry M Holley Md Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4100 Austin Peay Hwy, Memphis, TN 38128 Phone: 901-486-1151 Fax: 901-844-1439 | |
Spirit Health Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1331 Union Ave Ste 1240, Memphis, TN 38104 Phone: 901-832-6734 | |
Embrace Community Development Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1419 Breedlove St, Memphis, TN 38107 Phone: 901-484-3357 | |
Peabody Family Care, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1325 Eastmoreland Avenue, Suite 150, Memphis, TN 38104 Phone: 901-725-0648 Fax: 901-725-1037 | |
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