Shot Nurse-Memphis, P.C.

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

Legal business name

SHOT NURSE-MEMPHIS, P.C.

Practice address

4637 Poplar Ave
Memphis, TN 38117-4419

Phone

(901) 685-9999

Fax

(901) 767-8388

NPI assigned

Oct 28, 2008

Organization subpart

No

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

Authorized official

Name

Deborah Yvonne Overall, RN

Title

Vice-President

Phone

(901) 685-9999

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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
  • Cordova, TN
  • NPI 1275941106
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph Eugene Holley Jr., MD

  • General Practice Physician
  • Knoxville, TN
  • NPI 1952342586
  Medicare reassignment NPD

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406160000000",
    "number": "1659524148",
    "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": "4637 POPLAR AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381174419",
            "telephone_number": "901-685-9999",
            "fax_number": "901-767-8388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOT NURSE-MEMPHIS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2014-07-24",
        "status": "A",
        "authorized_official_last_name": "OVERALL",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "901-685-9999",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "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": []
}

• Alexandria Shores
• Riley Landon Short, MD
• Shorter
• Carl William Shorter, DNP
• Jermaine Shorter
• Shotrx, LLC
• Shots Plus More
• Crystal L Shotwell, APRN
• Tracey Shotwell, PHARMD
• Erin Shoughrue, CCC-SLP

• Community Health Clinic/Center in Memphis, TN
• Providers in Memphis, TN by specialty
• 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 enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.