Dr Jonathan J Ellichman, MD | |
6401 Poplar Ave Ste 410, Memphis, TN 38119-4808 | |
(901) 259-2718 | |
(901) 259-1123 |
Full Name | Dr Jonathan J Ellichman |
---|---|
Gender | Male |
Speciality | Vascular Surgery |
Experience | 25 Years |
Location | 6401 Poplar Ave Ste 410, Memphis, Tennessee |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1073538823 | NPI | - | NPPES |
30005342 | Medicaid | TN | |
165449001 | Medicaid | AR | |
06336753 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2086S0129X | Surgery - Vascular Surgery | 18972 (Mississippi) | Primary |
208G00000X | Thoracic Surgery (cardiothoracic Vascular Surgery) | 39618 (Tennessee) | Secondary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Southern Cardiovascular Pllc | 0042388373 | 2 |
Southern Cardiovascular Pllc | 0042388373 | 2 |
Southern Cardiovascular Pllc | 0042388373 | 2 |
Entity Name | Southern Cardiovascular Pllc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1447415104 PECOS PAC ID: 0042388373 Enrollment ID: O20130718000630 |
Mailing Address | Practice Location Address |
---|---|
Dr Jonathan J Ellichman, MD 1779 Kirby Pkwy # 1-511, Memphis, TN 38138-3666 Ph: (901) 371-5218 | Dr Jonathan J Ellichman, MD 6401 Poplar Ave Ste 410, Memphis, TN 38119-4808 Ph: (901) 259-2718 |
Leonard Harvey Hines, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 6005 Park Ave, Suite 821-b, Memphis, TN 38119 Phone: 901-726-1056 Fax: 901-726-5867 | |
Dr. Robert D Wallace, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1068 Cresthaven Rd Ste 500, Memphis, TN 38119 Phone: 901-866-8525 | |
William Leslie Hickerson, MD Surgery Medicare: Medicare Enrolled Practice Location: 890 Madison Ave, Suite Tg032, Memphis, TN 38103 Phone: 901-448-2579 Fax: 901-448-2602 | |
Dr. Dan Huff Shell Iii, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1068 Cresthaven Rd Ste 200, Memphis, TN 38119 Phone: 901-761-4844 Fax: 901-761-6929 | |
Randall William Franz, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1325 Eastmoreland Ave Ste 365, Memphis, TN 38104 Phone: 901-272-6018 Fax: 901-201-4203 | |
Dr. Christine T Mroz, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 6005 Park, #700, Memphis, TN 38119 Phone: 901-527-3391 Fax: 901-578-3969 | |
Miriam Wing San Tsao, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1211 Union Ave Suite 300, Memphis, TN 38104 Phone: 901-516-0792 Fax: 901-266-6415 |