Methodist Le Bonheur Community Outreach

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

METHODIST LE BONHEUR COMMUNITY OUTREACH

Practice address

77 Stonebridge Blvd
Jackson, TN 38305-2165

Phone

(901) 287-5961

NPI assigned

Sep 6, 2012

Organization subpart

No

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

Authorized official

Name

Pam Denise Burnett

Title

Manager of Operations

Phone

(731) 984-9963

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566172800000",
    "number": "1174872139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 VANN DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052095",
            "telephone_number": "731-499-0977",
            "fax_number": "731-499-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 STONEBRIDGE BLVD",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052165",
            "telephone_number": "901-287-5961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METHODIST LE BONHEUR COMMUNITY OUTREACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-06",
        "last_updated": "2019-08-19",
        "status": "A",
        "authorized_official_last_name": "BURNETT",
        "authorized_official_first_name": "PAM",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "MANAGER OF OPERATIONS",
        "authorized_official_telephone_number": "731-984-9963"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Community Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Cora Meredith
• Jaclyn Ann Meredith
• Caroline R Merwin
• Daniel R Merwin, D.D.S., M.S.
• Methodist Healthcare-Memphis Hospitals
• Barbara Meussner, OT
• Zachary Meyer, MD
• MHC, Inc
• Keith A Micetich, MD
• Michael E Steuer MD PC

• Pediatrics Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; 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.