| Support Solutions Of The Mid-south | |
|
5909 Shelby Oaks Dr Suite 100 Memphis TN 38134-7317 | |
| (901) 383-9193 | |
| (901) 383-9195 |
| Full Name | Support Solutions Of The Mid-south |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5909 Shelby Oaks Dr, Memphis, Tennessee |
| Authorized Official Name and Position | Larry Durbin (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9013839193 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Support Solutions Of The Mid-south 5909 Shelby Oaks Dr Suite 100 Memphis TN 38134-7317 Ph: (901) 383-9193 | Support Solutions Of The Mid-south 5909 Shelby Oaks Dr Suite 100 Memphis TN 38134-7317 Ph: (901) 383-9193 |
| NPI Number | 1407025539 |
|---|---|
| Provider Enumeration Date | 02/22/2008 |
| Last Update Date | 01/07/2010 |
| Medicare PECOS PAC ID | 0446418834 |
|---|---|
| Medicare Enrollment ID | O20120214000467 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407025539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | L3(20)4M4-038-6644 (Tennessee) | Primary |
| 253Z00000X | In Home Supportive Care | PSS0000000274 (Tennessee) | Secondary |
| Provider Name | Anna M Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063721314 PECOS PAC ID: 2163611104 Enrollment ID: I20110106000872 |
| Provider Name | Anne C Bryan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962912766 PECOS PAC ID: 5698039329 Enrollment ID: I20180505000015 |
| Provider Name | Johennett Galloway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740754100 PECOS PAC ID: 0547502312 Enrollment ID: I20190425002832 |
| Provider Name | Andrea Samberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417609827 PECOS PAC ID: 5193185387 Enrollment ID: I20230719003542 |
| Provider Name | Angela Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629799176 PECOS PAC ID: 4587025002 Enrollment ID: I20230801000943 |
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