Healthcare Provider Details

I. General information

NPI: 1497148704
Provider Name (Legal Business Name): SLEEP DOCTORS OF MEMPHIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 CENTERVIEW PKWY SUITE 115
CORDOVA TN
38018-4227
US

IV. Provider business mailing address

PO BOX 38272
GERMANTOWN TN
38183-0272
US

V. Phone/Fax

Practice location:
  • Phone: 901-752-0662
  • Fax: 901-756-8541
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number31816
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number31816
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31816
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. AMADO X FREIRE
Title or Position: OWNER
Credential: M.D.
Phone: 901-753-8361