1396737268 NPI number — INTERVENTIONAL ASSOCIATES OF MEMPHIS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396737268 NPI number — INTERVENTIONAL ASSOCIATES OF MEMPHIS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERVENTIONAL ASSOCIATES OF MEMPHIS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396737268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 N PAULINE ST
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38105-5105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-448-2786
Provider Business Mailing Address Fax Number:
901-448-1772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 N PAULINE ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38105-5105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-448-2786
Provider Business Practice Location Address Fax Number:
901-448-1772
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WOODSIDE
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
901-448-1644

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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