| Mshn Enterprises Llc | |
|
2056 Fletcher Creek Dr Ste 101 Memphis TN 38133-7060 | |
| (901) 410-9062 | |
| Not Available |
| Full Name | Mshn Enterprises Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2056 Fletcher Creek Dr Ste 101, Memphis, Tennessee |
| Authorized Official Name and Position | Christopher Glenn Stephenson (CIO) |
| Authorized Official Contact | 9014109062 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mshn Enterprises Llc 2057 Fletcher Creek Dr Memphis TN 38133-7059 Ph: (901) 825-8972 | Mshn Enterprises Llc 2056 Fletcher Creek Dr Ste 101 Memphis TN 38133-7060 Ph: (901) 410-9062 |
| NPI Number | 1467092932 |
|---|---|
| Provider Enumeration Date | 01/13/2020 |
| Last Update Date | 08/09/2024 |
| Certification Date | 08/09/2024 |
| Medicare PECOS PAC ID | 7416328513 |
|---|---|
| Medicare Enrollment ID | O20230128000031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467092932 | NPI | - | NPPES |
| 7544 | Medicaid | TN | |
| I000000031865 | Other | TN | TDMHS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | John C Bomar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922029586 PECOS PAC ID: 4880651603 Enrollment ID: I20041214000305 |
| Provider Name | Susan G Bell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649304726 PECOS PAC ID: 8325079841 Enrollment ID: I20050824001059 |
| Provider Name | Joshua L. Carmack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013613942 PECOS PAC ID: 4789058272 Enrollment ID: I20230324000077 |
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