Healthcare Provider Details

I. General information

NPI: 1720087802
Provider Name (Legal Business Name): PEDIATRIC ANESTHESIOLOGISTS P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N DUNLAP ST
MEMPHIS TN
38103-2800
US

IV. Provider business mailing address

PO BOX 342629
BARTLETT TN
38184-2629
US

V. Phone/Fax

Practice location:
  • Phone: 901-572-3060
  • Fax:
Mailing address:
  • Phone: 901-291-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberN/A
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIKRAM PATEL JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 901-291-2427