Healthcare Provider Details

I. General information

NPI: 1881686814
Provider Name (Legal Business Name): PEDIATRIC SEDATION SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/01/2007
Certification Date:
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 342767
BARTLETT TN
38184-2767
US

V. Phone/Fax

Practice location:
  • Phone: 901-869-5708
  • Fax:
Mailing address:
  • Phone: 901-291-2400
  • Fax: 901-379-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTIN I HERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 901-869-5708