Organization
UT MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY LOVE (CHIEF ADMINISTRATIVE OFFICER)
(901) 866-8105
Entity
Organization
Contact information
Practice address
1068 CRESTHAVEN RD STE 300, MEMPHIS, TN 38119-0809
(901) 866-8864
Mailing address
1068 CRESTHAVEN RD STE 300, MEMPHIS, TN 38119-0809
(901) 866-8864
Taxonomy
Speciality
Code
Description
License number
State
103TH0004X
Health Psychologist
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04721062
—
MS
05
—
107355002
—
AR
05
—
154277
—
AL
05
—
1780676650
—
IL
05
—
3715279
—
TN
05
—
500425103
—
MO
05
—
65906117
—
KY
Enumeration date
08/17/2005
Last updated
01/23/2025
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