Provider Demographics
NPI:1861759045
Name:FRAYSER MEDICAL CENTER INC.
Entity type:Organization
Organization Name:FRAYSER MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-358-0326
Mailing Address - Street 1:1750 FRAYSER BLVD
Mailing Address - Street 2:A
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-6439
Mailing Address - Country:US
Mailing Address - Phone:901-358-0326
Mailing Address - Fax:901-358-9010
Practice Address - Street 1:1750 FRAYSER BLVD
Practice Address - Street 2:A
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6439
Practice Address - Country:US
Practice Address - Phone:901-358-0326
Practice Address - Fax:901-358-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD016758261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
A98271Medicare UPIN