Provider Demographics
NPI:1174925143
Name:MEMPHIS MEN'S CLINIC, PC
Entity type:Organization
Organization Name:MEMPHIS MEN'S CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIERCZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-443-0475
Mailing Address - Street 1:5050 POPLAR AVE
Mailing Address - Street 2:STE 718
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38157-0101
Mailing Address - Country:US
Mailing Address - Phone:901-443-0475
Mailing Address - Fax:901-509-2926
Practice Address - Street 1:5050 POPLAR AVE
Practice Address - Street 2:STE 718
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38157-0101
Practice Address - Country:US
Practice Address - Phone:901-443-0475
Practice Address - Fax:901-509-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty