Healthcare Provider Details

I. General information

NPI: 1770895591
Provider Name (Legal Business Name): METHODIST SPECIALTY PHYSICIAN VI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 WESLEY DR SUITE 302
MEMPHIS TN
38116-6400
US

IV. Provider business mailing address

PO BOX 1000 DEPT 970
MEMPHIS TN
38148-1000
US

V. Phone/Fax

Practice location:
  • Phone: 901-260-2072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARIF A ABDUS-SALAAM
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 202-421-5138