NPIMap

Organization Active NPI

Southeast Mental Health Center, Inc

  • Clinic Pharmacy
  • Memphis, TN
National Provider Identifier
1063575165
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
762 Issued in TN
Legal business name
SOUTHEAST MENTAL HEALTH CENTER, INC
Practice address
2579 Douglass Ave
Southeast Mental Health Center
Memphis, TN 38114-2532
Phone
(901) 369-1484
Fax
(901) 312-7572
NPI assigned
Dec 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Owen Eugene Lawrence, MA
Title
Executive Director
Phone
(901) 369-1420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 762 TN Primary

Addresses

Primary practice location

2579 Douglass Ave
Southeast Mental Health Center
Memphis, TN 38114-2532

Mailing address

3810 Winchester Rd
Southeast Mental Health Center
Memphis, TN 38118-6045
Phone (901) 369-1420

Other identifiers 1

IdentifierTypeStateIssuer
399596MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090713000696 TN Part B Supplier - Clinic/Group Practice 4082766621 Receives reassigned benefits from 87 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Memphis, TN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Southeast M H C Pharmacy6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063575165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3810 WINCHESTER RD",
            "address_2": "SOUTHEAST MENTAL HEALTH CENTER",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381186045",
            "telephone_number": "901-369-1420",
            "fax_number": "901-369-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2579 DOUGLASS AVE",
            "address_2": "SOUTHEAST MENTAL HEALTH CENTER",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381142532",
            "telephone_number": "901-369-1484",
            "fax_number": "901-312-7572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MENTAL HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "OWEN",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "901-369-1420",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "TN",
            "license": "762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "399596",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.