Healthcare Provider Details

I. General information

NPI: 1275906067
Provider Name (Legal Business Name): RESURRECTION ER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3000 GETWELL RD EMERGENCY DEPARTMENT
MEMPHIS TN
38118-2205
US

IV. Provider business mailing address

4095 AMERICAN WAY SUITE 1
MEMPHIS TN
38118-8339
US

V. Phone/Fax

Practice location:
  • Phone: 901-369-8602
  • Fax:
Mailing address:
  • Phone: 901-271-9500
  • Fax: 901-271-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD DONLON
Title or Position: CEO
Credential: MD
Phone: 901-271-9500