Basic Information
| Provider Information | |||||||||
| NPI: | 1710015045 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUMPHREYS FAMILY PRACTICE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 PARK AVENUE SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016858245 | ||||||||
| FaxNumber: | 9016858248 | ||||||||
| Practice Location | |||||||||
| Address1: | 2550 PARK AVENUE SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016858245 | ||||||||
| FaxNumber: | 9016858248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 08/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | HOWELL | ||||||||
| AuthorizedOfficialFirstName: | NEENA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9016858245 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.