SHEA CLINIC NPI 1568427128

NPI Information

  • NPI: 1568427128
  • Provider Name: SHEA CLINIC
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • CLIA Number: 44D0314799
  • Address: 6133 POPLAR PIKE
    MEMPHIS, TN
    ZIP 38119
  • Phone: (901) 761-9720

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NPI Details

SHEA CLINIC is a specialist in Memphis, TN. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SHEA CLINIC NPI is 1568427128. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6133 POPLAR PIKE
MEMPHIS, TN
ZIP 38119-707
Phone: (901) 761-9720
Fax: (901) 683-8440

The provider's authorized official is John R Gross .
The authorized official title is Administrator and has the following contact phone number (901) 761-9720.

The CLIA number assigned to this NPI record is 44D0314799 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/18/2006 and was last updated on 4/24/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
13371125MEDICARE ID-TYPE UNSPECIFIEDTENNESSEEGROUP MEDICARE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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