Healthcare Provider's Profile
| Full Name | |
|---|
| Type | Facility |
|---|
| Speciality | Orthopaedic Surgery - Orthopaedic Surgery Of The Spine |
|---|
| Location | 5154 Stage Rd Ste 101, Memphis, Tennessee |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1740832823
- Provider Enumeration Date: 07/10/2019
- Last Update Date: 08/02/2019
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1740832823 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 111N00000X | Chiropractor | (* (Not Available)) | Secondary |
| 207X00000X | Orthopaedic Surgery | (* (Not Available)) | Secondary |
| 207XS0117X | Orthopaedic Surgery - Orthopaedic Surgery Of The Spine | (* (Not Available)) | Primary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | (* (Not Available)) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
2385 Nw Executive Center Dr Ste 150,
Boca Raton, FL 33431-7371
Ph: (954) 320-4600 |
5154 Stage Rd Ste 101,
Memphis, TN 38134-3118
Ph: (901) 444-3001 |
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