Healthcare Provider Details

I. General information

NPI: 1366643355
Provider Name (Legal Business Name): EAST MEMPHIS ELECTROGARDIOGRAPHERS ASSOCIATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE
MEMPHIS TN
38119-5200
US

IV. Provider business mailing address

PO BOX 241926
MEMPHIS TN
38124-1926
US

V. Phone/Fax

Practice location:
  • Phone: 901-821-0338
  • Fax: 901-821-0384
Mailing address:
  • Phone: 901-821-0338
  • Fax: 901-821-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMDTDL0451
License Number StateTN

VIII. Authorized Official

Name: EUGENE J SPIOTTA SR.
Title or Position: OWNER
Credential: MD
Phone: 901-821-0338