Basic Information
| Provider Information | |||||||||
| NPI: | 1386628329 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEMPHIS ORTHOPAEDIC GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3980 NEW COVINGTON PIKE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381282500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013822606 | ||||||||
| FaxNumber: | 9013730809 | ||||||||
| Practice Location | |||||||||
| Address1: | 3980 NEW COVINGTON PIKE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381282500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013822606 | ||||||||
| FaxNumber: | 9013730809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 02/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | HEIN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9019373232 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.