Healthcare Provider Details

I. General information

NPI: 1942976790
Provider Name (Legal Business Name): HOSPITAL MED ASSIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANUEL M. DIEGUEZ 360 MEXICO
PUERTO VALLARTA MEXICIO
48380
MX

IV. Provider business mailing address

HOSPITAL MED ASSIST 1779 KIRBY PKWY #12480 MEMPHIS, TN
MEMPHIS TN
38138
US

V. Phone/Fax

Practice location:
  • Phone: 650-417-1127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: IAN FISCHMAN
Title or Position: MANAGER
Credential:
Phone: 650-417-1127