Healthcare Provider Details

I. General information

NPI: 1568352771
Provider Name (Legal Business Name): VASCULAR INSTITUTE MS SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DECK STONE DR
BATESVILLE MS
38606-1097
US

IV. Provider business mailing address

6409 N QUAIL HOLLOW RD
MEMPHIS TN
38120-1414
US

V. Phone/Fax

Practice location:
  • Phone: 901-390-2930
  • Fax:
Mailing address:
  • Phone: 901-390-2930
  • Fax: 901-390-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: PRATEEK GUPTA
Title or Position: CO-OWNER
Credential: MD
Phone: 901-390-2930