FMSC Collierville Operating Company

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

314000000 Issued in TN

Legal business name

FMSC COLLIERVILLE OPERATING COMPANY

Doing business as

Collierville Health & Rehabilitation

Practice address

490 W Poplar Ave
Collierville, TN 38017-2538

Phone

(305) 892-1790

NPI assigned

Feb 7, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Theodore M Duay III, C.P.A.

Title

Chief Financial Officer

Phone

(786) 888-3310

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Collierville Health & Rehabilitation Doing business as

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259798400000",
    "number": "1477525905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 NE 125TH ST",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331615804",
            "telephone_number": "786-888-3310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 W POPLAR AVE",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380172538",
            "telephone_number": "305-892-1790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMSC COLLIERVILLE OPERATING COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2009-12-03",
        "status": "A",
        "authorized_official_last_name": "DUAY",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "786-888-3310",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "C.P.A."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "314000000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "744-0470",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collierville Health & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Zekeria Fleming
• Jennifer Flores
• Amber Floyd-Wehrenberg
• Brandalon Marie Fly, APRN, FNP-BC
• Tina Fly
• FMSC Collierville Operating Company LLC
• Erin Michelle Fontana, PTA
• Ira Dean Fontenot, P.D.
• Amir Victor Francis, D.D.S
• Alan Fredericks, D.C.

• Skilled Nursing Facility in Collierville, TN
• Providers in Collierville, TN by specialty
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; 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.