| Shot Nurse-memphis, P.C. | |
|
4637 Poplar Ave Memphis TN 38117-4419 | |
| (901) 685-9999 | |
| (901) 767-8388 |
| Full Name | Shot Nurse-memphis, P.C. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4637 Poplar Ave, Memphis, Tennessee |
| Authorized Official Name and Position | Deborah Yvonne Overall (VICE-PRESIDENT) |
| Authorized Official Contact | 9016859999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shot Nurse-memphis, P.C. 4637 Poplar Ave Memphis TN 38117-4419 Ph: (901) 685-9999 | Shot Nurse-memphis, P.C. 4637 Poplar Ave Memphis TN 38117-4419 Ph: (901) 685-9999 |
| NPI Number | 1659524148 |
|---|---|
| Provider Enumeration Date | 10/28/2008 |
| Last Update Date | 07/24/2014 |
| Medicare PECOS PAC ID | 7911141445 |
|---|---|
| Medicare Enrollment ID | O20130923000599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659524148 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (NU) | Primary |
| 172V00000X | Community Health Worker | (NU) | Secondary |
| Provider Name | Joseph Holley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952342586 PECOS PAC ID: 1850378829 Enrollment ID: I20040707000912 |
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