| South Md Pc | |
|
1300 Wesley Dr Memphis TN 38116-6426 | |
| (901) 570-7438 | |
| Not Available |
| Full Name | South Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1300 Wesley Dr, Memphis, Tennessee |
| Authorized Official Name and Position | Oluwatoyin Jimmy Agbaosi (PRESIDENT) |
| Authorized Official Contact | 9015707438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Md Pc Po Box 16384 Memphis TN 38186-0384 Ph: (901) 570-7438 | South Md Pc 1300 Wesley Dr Memphis TN 38116-6426 Ph: (901) 570-7438 |
| NPI Number | 1609129139 |
|---|---|
| Provider Enumeration Date | 10/22/2012 |
| Last Update Date | 06/03/2016 |
| Medicare PECOS PAC ID | 2668624735 |
|---|---|
| Medicare Enrollment ID | O20121218000595 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609129139 | NPI | - | NPPES |
| 1530261 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Tennessee) | Primary |
| Provider Name | Oluwatoyin Agbaosi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1265675201 PECOS PAC ID: 7810031820 Enrollment ID: I20100215000230 |
| Provider Name | Tina A Agbaosi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740423417 PECOS PAC ID: 7911179247 Enrollment ID: I20111011000384 |
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