1770895591 NPI number — METHODIST SPECIALTY PHYSICIAN VI

Table of content: DIANE ORSAK WILSON CNP CNS (NPI 1285731711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770895591 NPI number — METHODIST SPECIALTY PHYSICIAN VI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METHODIST SPECIALTY PHYSICIAN VI
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:
1770895591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1000
Provider Second Line Business Mailing Address:
DEPT 970
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38148-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1264 WESLEY DR
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38116-6400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-260-2072
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ABDUS-SALAAM
Authorized Official First Name:
SHARIF
Authorized Official Middle Name:
A
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
202-421-5138

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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