Basic Information
| Provider Information | |||||||||
| NPI: | 1578592663 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST MEMPHIS ANESTHESIA SERVICES PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 171181 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381871181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016826828 | ||||||||
| FaxNumber: | 9016829316 | ||||||||
| Practice Location | |||||||||
| Address1: | 5545 MURRAY AVE STE 130 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381193861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016822872 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 04/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | ESKIN | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9016822872 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 04/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 08138350 | 01 | MS | MS MEDICAID | OTHER | CA8885 | 01 | RAILROAD | OTHER |