NPIMap

Organization Active NPI

Extendimng Hearts HHC

  • Health Maintenance Organization
  • Memphis, TN
National Provider Identifier
1386017390
Registry record updated Nov 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
115005378 Issued in TN
Legal business name
EXTENDIMNG HEARTS HHC
Practice address
700 Parkdale Dr
Memphis, TN 38116-6212
Phone
(901) 462-1775
NPI assigned
Nov 12, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2015

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

Authorized official

Name
Myosha Johnson
Title
Owner
Phone
(901) 462-1775

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 115005378 TN Primary

Addresses

Primary practice location

700 Parkdale Dr
Memphis, TN 38116-6212

Mailing address

700 Parkdale Dr
Memphis, TN 38116-6212
Phone (901) 462-1775

Other identifiers 1

IdentifierTypeStateIssuer
1009180MedicaidTN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1447286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447286400000",
    "number": "1386017390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 PARKDALE DR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166212",
            "telephone_number": "901-462-1775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 PARKDALE DR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166212",
            "telephone_number": "901-462-1775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDIMNG HEARTS HHC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-12",
        "last_updated": "2015-11-12",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MYOSHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-462-1775"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "TN",
            "license": "115005378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009180",
            "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 Nov 12, 2015; 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.