| Healthy Life | |
|
3068 Covington Pike Ste 3 Memphis TN 38128-5001 | |
| (901) 385-6988 | |
| Not Available |
| Full Name | Healthy Life |
|---|---|
| Speciality | Family Medicine |
| Location | 3068 Covington Pike, Memphis, Tennessee |
| Authorized Official Name and Position | Griselle Virginia Figueredo Cardenas (OWNER) |
| Authorized Official Contact | 9013856988 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthy Life 3068 Covington Pike Ste 3 Memphis TN 38128-5001 Ph: (901) 385-6988 | Healthy Life 3068 Covington Pike Ste 3 Memphis TN 38128-5001 Ph: (901) 385-6988 |
| NPI Number | 1831365295 |
|---|---|
| Provider Enumeration Date | 05/06/2008 |
| Last Update Date | 01/29/2011 |
| Medicare PECOS PAC ID | 7416106653 |
|---|---|
| Medicare Enrollment ID | O20121004000115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831365295 | NPI | - | NPPES |
| 31712 | Other | TN | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 31712 (Tennessee) | Primary |
| Provider Name | Banjul L Covington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811155435 PECOS PAC ID: 6002956422 Enrollment ID: I20091216000209 |
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