Healthcare Provider Details

I. General information

NPI: 1356453773
Provider Name (Legal Business Name): THORACIC AND CARDIOVASCULAR SURGERY ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EASTMORELAND AVE SUITE 220
MEMPHIS TN
38104-3519
US

IV. Provider business mailing address

1325 EASTMORELAND AVE SUITE 220
MEMPHIS TN
38104-3519
US

V. Phone/Fax

Practice location:
  • Phone: 901-725-9450
  • Fax: 901-462-0675
Mailing address:
  • Phone: 901-725-9450
  • Fax: 901-462-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: GLENN PHILLIP SCHOETTLE
Title or Position: PRESIDENT
Credential: MD
Phone: 901-725-9450