Healthcare Provider Details

I. General information

NPI: 1992741482
Provider Name (Legal Business Name): AMISUB (SFH) INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5929 PARK AVE
MEMPHIS TN
38119-5150
US

IV. Provider business mailing address

PO BOX 741274
ATLANTA GA
30374-1274
US

V. Phone/Fax

Practice location:
  • Phone: 901-765-2057
  • Fax: 901-765-2077
Mailing address:
  • Phone: 901-523-7019
  • Fax: 901-259-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY ADAMS
Title or Position: SVP REGIONAL OPERATIONS, TENET
Credential:
Phone: 469-893-2563