Provider Demographics
NPI:1053340166
Name:MEMPHIS LUNG PHYSICIANS, P.C.
Entity type:Organization
Organization Name:MEMPHIS LUNG PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:UDOUJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-767-5864
Mailing Address - Street 1:6025 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2131
Mailing Address - Country:US
Mailing Address - Phone:901-767-5864
Mailing Address - Fax:901-767-6591
Practice Address - Street 1:6025 WALNUT GROVE RD
Practice Address - Street 2:SUITE 508
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2131
Practice Address - Country:US
Practice Address - Phone:901-767-5864
Practice Address - Fax:901-767-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09010462Medicaid
TN3381272Medicaid
TN3381272Medicaid
MS09010462Medicaid