Basic Information
| Provider Information | |||||||||
| NPI: | 1578620803 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE HEART CENTER OF MEMPHIS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2044 | ||||||||
| Address2: | DEPT 4300 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381012044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015076600 | ||||||||
| FaxNumber: | 9015076599 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 UNION AVE | ||||||||
| Address2: | SUITE 495 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381046638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015076600 | ||||||||
| FaxNumber: | 9015076599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 09/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | MARLENE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9018210338 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD0000028889 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 3723803 | 05 | TN | MEDICAID |