Otylia Primary Care, Llc | |
4913 Raleigh Common Dr Ste 201 Memphis TN 38128-2485 | |
(901) 878-3366 | |
(901) 492-4941 |
Full Name | Otylia Primary Care, Llc |
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Speciality | Family Medicine |
Location | 4913 Raleigh Common Dr Ste 201, Memphis, Tennessee |
Authorized Official Name and Position | Krzysztof Tyszka (OWNER) |
Authorized Official Contact | 9018783366 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Otylia Primary Care, Llc 4913 Raleigh Common Dr Ste 201 Memphis TN 38128-2485 Ph: (901) 878-3366 | Otylia Primary Care, Llc 4913 Raleigh Common Dr Ste 201 Memphis TN 38128-2485 Ph: (901) 878-3366 |
NPI Number | 1437704079 |
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Provider Enumeration Date | 08/08/2019 |
Last Update Date | 08/27/2019 |
Medicare PECOS PAC ID | 5395177034 |
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Medicare Enrollment ID | O20191118002006 |
Identifier | Type | State | Issuer |
---|---|---|---|
1437704079 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Whitaker M Smith |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1003827205 PECOS PAC ID: 8527075647 Enrollment ID: I20100318000245 |
Provider Name | Katosha A Muse |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1366763435 PECOS PAC ID: 2365688280 Enrollment ID: I20130820000747 |
Provider Name | Pauline Michelle Mays |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1174049985 PECOS PAC ID: 9830423870 Enrollment ID: I20190626000542 |
Provider Name | Ashley N Byrd |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104218312 PECOS PAC ID: 3779811559 Enrollment ID: I20190819002333 |
Provider Name | Arqutia Hill |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1386294759 PECOS PAC ID: 7719313063 Enrollment ID: I20200204001614 |
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