| Radiant Life Healthcare Pc | |
|
333 S Bellevue Blvd Memphis TN 38104-3530 | |
| (901) 729-2708 | |
| (901) 729-2720 |
| Full Name | Radiant Life Healthcare Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 333 S Bellevue Blvd, Memphis, Tennessee |
| Authorized Official Name and Position | Russell D Beis (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9015824059 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiant Life Healthcare Pc 1072 Wedgewood St Memphis TN 38111-8138 Ph: (901) 582-4059 | Radiant Life Healthcare Pc 333 S Bellevue Blvd Memphis TN 38104-3530 Ph: (901) 729-2708 |
| NPI Number | 1407615677 |
|---|---|
| Provider Enumeration Date | 03/18/2024 |
| Last Update Date | 03/18/2024 |
| Medicare PECOS PAC ID | 0749628766 |
|---|---|
| Medicare Enrollment ID | O20240409004078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407615677 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Russell D Beis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942256102 PECOS PAC ID: 2668412248 Enrollment ID: I20050504000135 |
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