Healthcare Provider Details

I. General information

NPI: 1396737268
Provider Name (Legal Business Name): INTERVENTIONAL ASSOCIATES OF MEMPHIS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 N PAULINE ST SUITE 206
MEMPHIS TN
38105-5105
US

IV. Provider business mailing address

66 N PAULINE ST SUITE 206
MEMPHIS TN
38105-5105
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-2786
  • Fax: 901-448-1772
Mailing address:
  • Phone: 901-448-2786
  • Fax: 901-448-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY R. WOODSIDE
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 901-448-1644