Healthcare Provider Details

I. General information

NPI: 1053362749
Provider Name (Legal Business Name): MEMPHIS CARDIAC CARE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EASTMORELAND AVE SUITE 440
MEMPHIS TN
38104-3519
US

IV. Provider business mailing address

PO BOX 381588
GERMANTOWN TN
38183-1588
US

V. Phone/Fax

Practice location:
  • Phone: 901-722-8884
  • Fax: 901-276-1436
Mailing address:
  • Phone: 901-722-8884
  • Fax: 901-276-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD0000035150
License Number StateTN

VIII. Authorized Official

Name: SUNIL JHA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 901-722-8884