Healthcare Provider Details

I. General information

NPI: 1073624995
Provider Name (Legal Business Name): MEMPHIS EMERGENCY SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6426 HIGHWAY 51 N
HORN LAKE MS
38637-2474
US

IV. Provider business mailing address

6426 HIGHWAY 51 N
HORN LAKE MS
38637-2474
US

V. Phone/Fax

Practice location:
  • Phone: 662-342-4080
  • Fax: 662-342-4933
Mailing address:
  • Phone: 662-342-4080
  • Fax: 662-342-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMS6971
License Number StateMS

VIII. Authorized Official

Name: MICHAEL T ZANONE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 662-342-4080