1336816388 NPI number — METROPOLITAN CARDIOVASCULAR INSTITUTE

Table of content: MR. TODD ALAN RICHARDSON D.C.P.A. (NPI 1174634679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336816388 NPI number — METROPOLITAN CARDIOVASCULAR INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN CARDIOVASCULAR INSTITUTE
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:
6
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:
1336816388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2386 CARTERS GROVE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38138-4904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-596-4096
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1975 NONCONNAH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38132-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-337-1625
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2021

Additional Information

Authorized Official

Authorized Official Last Name:
DISHMON
Authorized Official First Name:
DWIGHT
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
901-596-4096

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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