NPIMap

Organization Active NPI

Memphis Children'S Clinic

  • Pediatrics Physician
  • Bartlett, TN
National Provider Identifier
1740362896
Registry record updated Nov 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MEMPHIS CHILDREN'S CLINIC
Practice address
6385 Stage Road
Suite 2
Bartlett, TN 38134
Phone
(901) 386-1683
Fax
(901) 385-8252
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2014

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

Authorized official

Name
Dr. Timothy G. Gillespie, M.D
Title
Cmo
Phone
(901) 396-0390

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X MD0000008001 TN

Addresses

Primary practice location

6385 Stage Road
Suite 2
Bartlett, TN 38134

Mailing address

1129 Hale Road
Memphis, TN 38116-6397
Phone (901) 396-0390

Other identifiers 2

IdentifierTypeStateIssuer
3382354MedicaidTN
5440448MedicaidTN

Other names 1

  • Bartlett Children's Clinic Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Memphis Children'S Clinic7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1129 Hale Rd
Memphis, TN 38116
Phone (901) 396-0390

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415145600000",
    "number": "1740362896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 HALE ROAD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166397",
            "telephone_number": "901-396-0390",
            "fax_number": "901-507-7561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6385 STAGE ROAD",
            "address_2": "SUITE 2",
            "city": "BARTLETT",
            "state": "TN",
            "postal_code": "38134",
            "telephone_number": "901-386-1683",
            "fax_number": "901-385-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMPHIS CHILDREN'S CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2014-11-05",
        "status": "A",
        "authorized_official_last_name": "GILLESPIE",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "901-396-0390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD0000008001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3382354",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5440448",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bartlett Children's Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bartlett, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2014; 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.