Provider Demographics
NPI:1053393231
Name:SHELBY COUNTY HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:SHELBY COUNTY HEALTH CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP/CHIEF LEGAL OFFICER & GENERAL C
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WHARTON
Authorized Official - Suffix:
Authorized Official - Credentials:ESQUIRE
Authorized Official - Phone:901-545-8223
Mailing Address - Street 1:877 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:901-545-6060
Mailing Address - Fax:
Practice Address - Street 1:890 MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103
Practice Address - Country:US
Practice Address - Phone:901-545-6060
Practice Address - Fax:901-545-6060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBY COUNTY HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000110283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN181191Medicaid
TN181191Medicaid