Provider Demographics
NPI:1861719445
Name:TOTAL HEATLH CARE
Entity type:Organization
Organization Name:TOTAL HEATLH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:901-332-5873
Mailing Address - Street 1:PO BOX 30384
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38130-0384
Mailing Address - Country:US
Mailing Address - Phone:901-332-5873
Mailing Address - Fax:
Practice Address - Street 1:4299 ELVIS PRESLEY B;VD.
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6435
Practice Address - Country:US
Practice Address - Phone:901-332-5873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13959208D00000X
TN18656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty