1407981467 NPI number — MEMPHIS SURGICAL SPECIALISTS, PC

Table of content: (NPI 1407981467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407981467 NPI number — MEMPHIS SURGICAL SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMPHIS SURGICAL SPECIALISTS, 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:
RAZA A. DILAWARI, M.D., P.C.
Provider Other Organization Name Type Code:
4
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:
1407981467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3950 NEW COVINGTON PIKE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38128-2595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-382-3333
Provider Business Mailing Address Fax Number:
901-382-5153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3950 NEW COVINGTON PIKE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38128-2595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-382-3333
Provider Business Practice Location Address Fax Number:
901-382-5153
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LUNSFORD
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
901-382-3333

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086X0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3384664 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3898079 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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