| Goodlife Medical Center, Pllc | |
|
756 Ridge Lake Blvd Suite 228 Memphis TN 38120-9420 | |
| (901) 685-1994 | |
| (901) 685-1997 |
| Full Name | Goodlife Medical Center, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 756 Ridge Lake Blvd, Memphis, Tennessee |
| Authorized Official Name and Position | Olugbenga Adebanjo (PRESIDENT) |
| Authorized Official Contact | 9016851994 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Goodlife Medical Center, Pllc Po Box 172126 Memphis TN 38187-2126 Ph: (901) 685-1994 | Goodlife Medical Center, Pllc 756 Ridge Lake Blvd Suite 228 Memphis TN 38120-9420 Ph: (901) 685-1994 |
| NPI Number | 1811041668 |
|---|---|
| Provider Enumeration Date | 01/22/2007 |
| Last Update Date | 09/20/2007 |
| Medicare PECOS PAC ID | 2567423445 |
|---|---|
| Medicare Enrollment ID | O20041023000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811041668 | NPI | - | NPPES |
| 3726671 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 37598 (Tennessee) | Primary |
| Provider Name | Olugbenga Adebanjo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144274200 PECOS PAC ID: 3779478557 Enrollment ID: I20040219000753 |
| Provider Name | Titilola Adebanjo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730304916 PECOS PAC ID: 6406936137 Enrollment ID: I20080107000681 |
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