Superiorcare Medical Group LLC
Nurse Practitioner, Family in Cordova, TN. Organization (NPI-2).
NPI number1124802178
StatusActive
Last updated in NPPESDec 11, 2024
Details
- NPI
- 1124802178
- Entity type
- Organization (NPI-2)
- Legal business name
- Superiorcare Medical Group LLC
- Organization subpart
- No
- Enumeration date
- Aug 22, 2023
- Certification date
- Dec 11, 2024
- Last updated
- Dec 11, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | – | – | Yes |
| 207Q00000X | Family Medicine | – | – | |
| 363LP2300X | Nurse Practitioner, Primary Care | – | – |
Practice location
1175 Vickery Ln Ste 101Cordova, TN 38016-0682
Phone 662-408-6995
Mailing address
3750 Hacks Cross Rd # 102-202Memphis, TN 38125-2367
Phone 662-408-6995
Other practice locations
1223 Main St Ste B
Southaven, MS 38671-1429
Southaven, MS 38671-1429
Phone 662-408-6995
Authorized official
Donna Luckett
Member
6624037741
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