| Tri-state Neurology Pllc | |
|
5100 Sanderlin Ave Ste 2100 Memphis TN 38117-4387 | |
| (901) 820-0141 | |
| (901) 820-0144 |
| Full Name | Tri-state Neurology Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5100 Sanderlin Ave Ste 2100, Memphis, Tennessee |
| Authorized Official Name and Position | James J Wang (PRESIDENT / OWNER) |
| Authorized Official Contact | 9018200141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri-state Neurology Pllc 5100 Sanderlin Ave Ste 2100 Memphis TN 38117-4387 Ph: (901) 820-0141 | Tri-state Neurology Pllc 5100 Sanderlin Ave Ste 2100 Memphis TN 38117-4387 Ph: (901) 820-0141 |
| NPI Number | 1184788762 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 11/30/2017 |
| Medicare PECOS PAC ID | 1355449737 |
|---|---|
| Medicare Enrollment ID | O20110725000722 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184788762 | NPI | - | NPPES |
| 138488001 | Medicaid | AR | |
| 206187502 | Medicaid | MO | |
| 00126261 | Medicaid | MS | |
| 3838091 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | MD0000030878 (Tennessee) | Primary |
| Provider Name | James Jinxing Wang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619945532 PECOS PAC ID: 7214915370 Enrollment ID: I20040713001491 |
| Provider Name | Rada Petrinjac-nenadic |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1891911954 PECOS PAC ID: 2062583230 Enrollment ID: I20080616000245 |
| Provider Name | Ahmad B Al-hamda |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1851357586 PECOS PAC ID: 5890857866 Enrollment ID: I20081229000647 |
| Provider Name | Pawan Rawal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1255659009 PECOS PAC ID: 6305083478 Enrollment ID: I20150918001526 |
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