NPIMap

Organization Active NPI

Goodlife Medical Center, PLLC

  • Internal Medicine Physician
  • Memphis, TN
National Provider Identifier
1811041668
Registry record updated Sep 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
37598 Issued in TN
Legal business name
GOODLIFE MEDICAL CENTER, PLLC
Practice address
756 Ridge Lake Blvd
Suite 228
Memphis, TN 38120-9420
Phone
(901) 685-1994
Fax
(901) 685-1997
NPI assigned
Jan 22, 2007
Last updated
Sep 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2007

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

Authorized official

Name
Olugbenga Adebanjo, MDNPI 1144274200
Title
President
Phone
(901) 685-1994

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 37598 TN Primary

Addresses

Primary practice location

756 Ridge Lake Blvd
Suite 228
Memphis, TN 38120-9420

Mailing address

PO Box 172126
Memphis, TN 38187-2126
Phone (901) 685-1994

Other identifiers 1

IdentifierTypeStateIssuer
3726671MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041023000283 TN Part B Supplier - Clinic/Group Practice 2567423445 Receives reassigned benefits from 2 practitioners
Practice locations: Memphis, TN

National Provider Directory

National Provider Directory

Locations

1264 Wesley Dr
Ste 301
Memphis, TN 38116
Phone (901) 345-1022

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190246400000",
    "number": "1811041668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 172126",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381872126",
            "telephone_number": "901-685-1994",
            "fax_number": "901-685-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "756 RIDGE LAKE BLVD",
            "address_2": "SUITE 228",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209420",
            "telephone_number": "901-685-1994",
            "fax_number": "901-685-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODLIFE MEDICAL CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-09-20",
        "status": "A",
        "authorized_official_last_name": "ADEBANJO",
        "authorized_official_first_name": "OLUGBENGA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-685-1994",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "37598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3726671",
            "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 Sep 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.