| Dr Luis Campos-de-la-borbolla, MD | |
|
1265 Union Ave, Suite 184, Memphis, TN 38104-3415 | |
| (901) 516-0929 | |
| (901) 516-8993 |
| Full Name | Dr Luis Campos-de-la-borbolla |
|---|---|
| Gender | Male |
| Speciality | Surgery |
| Location | 1265 Union Ave, Memphis, Tennessee |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487677548 | NPI | - | NPPES |
| 00873097 | Medicaid | MS | |
| Q002436 | Medicaid | TN | |
| 4355465 | Other | TN | BCBS |
| 170500001 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | D0060736 (Maryland) | Secondary |
| 208600000X | Surgery | 44107 (Tennessee) | Primary |
| Entity Name | Saint Thomas Medical Partners |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1437194669 PECOS PAC ID: 1557269354 Enrollment ID: O20031230000470 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Luis Campos-de-la-borbolla, MD Po Box 1000, Dept # 457, Memphis, TN 38148-0001 Ph: (901) 516-0929 | Dr Luis Campos-de-la-borbolla, MD 1265 Union Ave, Suite 184, Memphis, TN 38104-3415 Ph: (901) 516-0929 |
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 |