Shot Nurse-Memphis, P.C.

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

Legal business name

SHOT NURSE-MEMPHIS, P.C.

Practice address

714 N Germantown Pkwy
Suite 11
Cordova, TN 38018-6280

Phone

(901) 685-9999

NPI assigned

Jul 23, 2014

Organization subpart

No

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

Authorized official

Name

Deborah Overall, RN

Title

Vice-President

Phone

(901) 685-9999

Specialties & licenses 2

Addresses

Other names 1

• The Shot Nurse Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Shot Nurse-Memphis PC3 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.

• Shot Nurse-Memphis, P.C.

  • Health Service Clinic/Center
  • Germantown, TN
  • NPI 1134537061
  NPD tax ID
• Shot Nurse-Memphis, P.C.

  • Community Health Clinic/Center
  • Memphis, TN
  • NPI 1659524148
  NPD tax ID

Locations

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

{
    "created_epoch": "1406073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406160000000",
    "number": "1275941106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4637 POPLAR AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381174419",
            "telephone_number": "901-685-9999",
            "fax_number": "901-767-8388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 N GERMANTOWN PKWY",
            "address_2": "SUITE 11",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380186280",
            "telephone_number": "901-685-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOT NURSE-MEMPHIS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-23",
        "last_updated": "2014-07-24",
        "status": "A",
        "authorized_official_last_name": "OVERALL",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "901-685-9999",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Shot Nurse",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Regina Sade Shields-Johnson
• Antonni Lashae Shingles
• Marganhally Shivaram, M.D.
• Raquel Shoats
• James Joshua Short
• Victoria Siddell
• Jessika Lorraine Sievers
• Rhonda Renee Sills
• Tiffany Marie Silva
• Simba Rehab, LLC

• All providers in Cordova, TN
• Community Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.