NPIMap

Organization Active NPI

Medipharm Inc.

Doing business as MediPharm Health Clinic

  • Internal Medicine Physician
  • Memphis, TN
National Provider Identifier
1033406111
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD7664 Issued in TN
Legal business name
MEDIPHARM INC.
Doing business as
MediPharm Health Clinic
Practice address
295 S Bellevue Blvd
Suite # 3
Memphis, TN 38104-7517
Phone
(901) 746-9631
Fax
(901) 791-9292
NPI assigned
Jul 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nyanday R. Oti
Title
Administrator/Ceo
Phone
(901) 746-9631

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X MD7664 TN Primary
Phlebotomy TechnicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 246RP1900X 44D2021574 TN
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X APN 16134 TN

Addresses

Primary practice location

295 S Bellevue Blvd
Suite # 3
Memphis, TN 38104-7517

Mailing address

295 S Bellevue Blvd
Suite # 3
Memphis, TN 38104-7517
Phone (901) 746-9631

Other identifiers 2

IdentifierTypeStateIssuer
1780980631OtherTNSPECIALTY PHARMACY
1942476528OtherTNRETAIL PHARMACY

Other names 1

  • MediPharm Health Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medipharm Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

295 S Bellevue Blvd
Ste 3
Memphis, TN 38104
Phone (901) 746-9631

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1033406111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 S BELLEVUE BLVD",
            "address_2": "SUITE # 3",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381047517",
            "telephone_number": "901-746-9631",
            "fax_number": "901-791-9292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 S BELLEVUE BLVD",
            "address_2": "SUITE # 3",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381047517",
            "telephone_number": "901-746-9631",
            "fax_number": "901-791-9292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIPHARM INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-08",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "OTI",
        "authorized_official_first_name": "NYANDAY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "901-746-9631"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD7664",
            "primary": true
        },
        {
            "code": "246RP1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": "TN",
            "license": "44D2021574",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN 16134",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECIALTY PHARMACY",
            "identifier": "1780980631",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RETAIL PHARMACY",
            "identifier": "1942476528",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MediPharm Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.