1023011236 NPI number — DR. ELISABETH E ADDERSON MD

Table of content: DR. ELISABETH E ADDERSON MD (NPI 1023011236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023011236 NPI number — DR. ELISABETH E ADDERSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADDERSON
Provider First Name:
ELISABETH
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1023011236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
262 DANNY THOMAS PLACE., MS 0515
Provider Second Line Business Mailing Address:
ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38105-3678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-595-3006
Provider Business Mailing Address Fax Number:
901-595-3842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
262 DANNY THOMAS PLACE., MS 0515
Provider Second Line Business Practice Location Address:
ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-595-3006
Provider Business Practice Location Address Fax Number:
901-595-3842
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0208X , with the licence number:  31812 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100179830A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200379130A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00121227 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138461001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1561843 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 422400000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205026305 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3897997 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64008287 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104788392 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0527788 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1146360 00 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200253180A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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