MEDICARE: SOUTHWIND ENDOSCOPY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1245242817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWIND ENDOSCOPY CENTER

Provider Business Mailing Address
First Line	:	3725 CHAMPION HILLS DR
Second Line	:	SUITE 200
City	:	MEMPHIS
State	:	TN
Zip	:	38125-2597
Country	:	US
Telephone Number	:	901-367-9001
Fax Number	:

Provider Business Practice Location Address
First Line	:	3725 CHAMPION HILLS DR
Second Line	:	#2000
City	:	MEMPHIS
State	:	TN
Zip	:	38125-2597
Country	:	US
Telephone Number	:	901-367-9001
Fax Number	:	901-565-8787

Authorized Official
Title or Position	:	PHYSICIAN/ PART OWNER
Name	:	RONALD MICHAEL
Credential	:	M.D.
Telephone Number	:	901-367-9001

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	11/30/2011

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Directions to “SOUTHWIND ENDOSCOPY CENTER ” Practice Location

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