Basic Information
| Provider Information | |||||||||
| NPI: | 1275906067 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESURRECTION ER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4095 AMERICAN WAY | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381188339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012719500 | ||||||||
| FaxNumber: | 9012719501 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 GETWELL RD | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381182205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013698602 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2015 | ||||||||
| LastUpdateDate: | 11/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | DONLON | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9012719500 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RESURRECTION HEALTH | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.