| Shotrx, Llc | |
|
6084 Apple Tree Dr Ste 10 Memphis TN 38115-0305 | |
| (901) 779-6500 | |
| (901) 779-6555 |
| Full Name | Shotrx, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 6084 Apple Tree Dr Ste 10, Memphis, Tennessee |
| Authorized Official Name and Position | Andrea Ivory Fuller (DIRECTOR OF HR AND BILLING) |
| Authorized Official Contact | 9016433556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shotrx, Llc 6084 Apple Tree Dr Ste 10 Memphis TN 38115-0305 Ph: (901) 779-6500 | Shotrx, Llc 6084 Apple Tree Dr Ste 10 Memphis TN 38115-0305 Ph: (901) 779-6500 |
| NPI Number | 1154990943 |
|---|---|
| Provider Enumeration Date | 06/24/2021 |
| Last Update Date | 06/12/2024 |
| Medicare PECOS PAC ID | 6406245174 |
|---|---|
| Medicare Enrollment ID | O20211118001204 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154990943 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Dwight Anthony Dishmon |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316904048 PECOS PAC ID: 9931165941 Enrollment ID: I20041201001010 |
| Provider Name | Trevina H Springer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669449484 PECOS PAC ID: 3971530593 Enrollment ID: I20050725001095 |
| Provider Name | Janet Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043682677 PECOS PAC ID: 7315247574 Enrollment ID: I20151120000354 |
| Provider Name | Domecia Michelle Newmon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043752009 PECOS PAC ID: 4183907967 Enrollment ID: I20180730003255 |
| Provider Name | Tammy Delaney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437812351 PECOS PAC ID: 0840689592 Enrollment ID: I20211118000337 |
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