NPIMap

Organization Active NPI

Memphis Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Memphis, TN
National Provider Identifier
1144236902
Registry record updated Jan 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MEMPHIS HEALTH CENTER, INC.
Practice address
360 E H Crump Blvd
Memphis, TN 38126
Phone
(901) 261-2000
Fax
(901) 946-9262
NPI assigned
Aug 1, 2006
Last updated
Jan 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2023

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

Authorized official

Name
Mrs. Marilyn Burress
Title
Chief Executive Officer (Ceo)
Phone
(901) 261-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

360 E H Crump Blvd
Memphis, TN 38126

Mailing address

360 E H Crump Blvd
Memphis, TN 38126
Phone (901) 261-2000

Other identifiers 1

IdentifierTypeStateIssuer
1525381MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031103000245 TN Part B Supplier - Clinic/Group Practice 7315859972 Receives reassigned benefits from 80 practitioners
3 other NPIs on this enrollment
Practice locations: Memphis, TN; Rossville, TN
O20110112000007 WI Part A Provider - Federally Qualified Health Center (FQHC) 7315859972 Practice locations: Memphis, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144236902. Details of each certification follow.

Federally qualified health center certification: CCN 441810

Legal name
MEMPHIS HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1991 in TN
Enrollment address
360 E Eh Crump Blvd
Memphis, TN 38126-5310

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Memohis Health Center I5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

4940 Highway 57
Rossville, TN 38066
Phone (901) 261-2221

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Theresa Isom Individual Corporate DirectorBoard Member Jan 1, 2011
Marilyn Burress Individual Corporate DirectorCeo Aug 2, 2020
Anderson Williams Individual Corporate DirectorBoard Member Jan 1, 2011
Eric Mayse Individual Corporate OfficerCfo Jan 1, 2019
Lois Stockton Individual Corporate DirectorBoard Member Jan 1, 2011
Aisha Barber Individual Corporate DirectorBilling Director Jan 1, 2021
W-2 Managing EmployeeBilling Director Jan 1, 2021
Binder Jones Individual Corporate DirectorBoard Member Jul 12, 2014
Howard Demesma Individual Corporate DirectorBoard Member Jan 1, 2011
Coleman Thompson Individual Corporate DirectorBoard Member Jan 1, 2011

Practitioners & affiliated clinicians

Practitioners 84

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 84

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674432000000",
    "number": "1144236902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 E H CRUMP BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38126",
            "telephone_number": "901-261-2000",
            "fax_number": "901-946-9262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 E H CRUMP BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38126",
            "telephone_number": "901-261-2000",
            "fax_number": "901-946-9262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMPHIS HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A",
        "authorized_official_last_name": "BURRESS",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER (CEO)",
        "authorized_official_telephone_number": "901-261-2000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1525381",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.