Organization
METHODIST PHYSICIAN PRACTICE LLC
Active
Organization
METHODIST PHYSICIAN PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLIN COSTELLO (CFO)
(901) 478-0889
Entity
Organization
Contact information
Practice address
1211 UNION AVE STE 330, MEMPHIS, TN 38104-6655
(901) 478-0954
(901) 478-0951
Mailing address
1211 UNION AVE STE 700, MEMPHIS, TN 38104-6600
(901) 478-0954
(901) 478-0951
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
08/26/2020
Last updated
08/26/2020
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