SUSAN E INGRAM CENTER - NPI 1144386855 - Pharmacy in Millington, TN

Q: What is the provider's specialty?

The provider's specialty is Pharmacy with taxonomy code 3336L0003X and a focus in Long Term Care Pharmacy.

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About Susan E Ingram Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUSAN E INGRAM CENTER (NPI 1144386855) is a healthcare organization registered as a long term care pharmacy in Millington, Tennessee and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through November 23, 2026 and lists Tom Griffin, Controller, as its authorized official.

NPPES Registry Identity

NPI1144386855

Entity TypeOrganization

Primary Taxonomy3336L0003X

Legal Business NamePROFESSIONAL CARE SERVICES OF WEST TN INC

Location Address5281 NAVY RDMillington, TN 38053-2535

Mailing Address1997 Hwy 51 SCovington, TN 38019-3630 · (901) 476-8967 · Fax (901) 313-1125

Phone(901) 873-0305

Fax(901) 873-0306

Organization SubpartNo

Authorized OfficialTom GriffinController · (901) 622-1688

Enumeration DateDecember 28, 2006

Last NPPES UpdateJuly 9, 2019

✔ NPI 1144386855 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Long Term Care PharmacySuppliers

Taxonomy Code3336L0003X

Definition

A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X · License 3856 (TN)

5281 NAVY RD, Millington, TN 38053

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Other Names 1

Doing Business AsSusan E Ingram Center

Other Identifiers 1

Other4436350Ncpdp

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D2202028

Professional Care Services Of West Tn Inc · Covington, TN

Active · expires Nov 23, 2026

CLIA Number44D2202028

Laboratory TypeCommunity Clinic

Certificate Effective DateNovember 24, 2024

Certificate Expiration DateNovember 23, 2026

Laboratory DirectorEdgar J. Jackson

Laboratory Phone(901) 622-1641

Laboratory LocationProfessional Care Services Of West Tn Inc1997 Highway 51 South, Covington, TN 38019

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. BONNIE LOU BARAKAT-SMITH MS

Counselor (Mental Health)