NPIMap

Organization Active NPI

Memphis Children's Clinic, PLLC

  • Pediatrics Physician
  • Southaven, MS
National Provider Identifier
1790865616
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MEMPHIS CHILDREN'S CLINIC, PLLC
Practice address
7672 Airways Blvd
Southaven, MS 38671-5304
Phone
(662) 349-2555
Fax
(662) 349-0700
NPI assigned
Oct 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Robert M Bertin
Title
Practice Manager
Phone
(901) 396-0390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

7672 Airways Blvd
Southaven, MS 38671-5304

Mailing address

1129 Hale Rd
Memphis, TN 38116-6373
Phone (901) 396-0390

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

9860 Goodman Rd
Olive Branch, MS 38654
Phone (662) 890-0158

7672 Airways Blvd
Southaven, MS 38671
Phone (601) 349-1999

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790865616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 HALE RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166373",
            "telephone_number": "901-396-0390",
            "fax_number": "901-396-3728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7672 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715304",
            "telephone_number": "662-349-2555",
            "fax_number": "662-349-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMPHIS CHILDREN'S CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERTIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "901-396-0390",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.