Basic Information
| Provider Information | |||||||||
| NPI: | 1972792117 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HELMICK | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 | ||||||||
| Address2: | DEPT # 457 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015169183 | ||||||||
| FaxNumber: | 9015168993 | ||||||||
| Practice Location | |||||||||
| Address1: | 1265 UNION AVE | ||||||||
| Address2: | SUITE 184 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381043415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015169183 | ||||||||
| FaxNumber: | 9015168993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 11/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 53310 | TN | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 57.013910 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | P2667 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 106876 | MN | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 106883 | MN | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 56911 | MN | N | Allopathic & Osteopathic Physicians | Surgery | 204F00000X | 53310 | TN | N | Allopathic & Osteopathic Physicians | Transplant Surgery |
ID Information
| ID | Type | State | Issuer | Description | Q014206 | 05 | TN | MEDICAID |