Provider Demographics
NPI:1174872295
Name:UT MEDICAL GROUP
Entity type:Organization
Organization Name:UT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEONATAL NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUIRHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:NNP-BC
Authorized Official - Phone:901-545-7366
Mailing Address - Street 1:179 EASTLAND DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6930
Mailing Address - Country:US
Mailing Address - Phone:901-761-2979
Mailing Address - Fax:
Practice Address - Street 1:853 JEFFERSON AVE
Practice Address - Street 2:ROOM 201
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-7366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8199402282NW0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8198662OtherADVANCED PRACTICE LIICENSE