Healthcare Provider Details

I. General information

NPI: 1861579393
Provider Name (Legal Business Name): MEMPHIS AREA PERFUSION (MAP)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 WALNUT GROVE RD
MEMPHIS TN
38120-2113
US

IV. Provider business mailing address

4803 NEW AIRLINE RD
ARLINGTON TN
38002-9586
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-5000
  • Fax:
Mailing address:
  • Phone: 901-867-4867
  • Fax: 901-867-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberCP0000000030
License Number StateTN

VIII. Authorized Official

Name: GARY BECKMAN
Title or Position: PRESEDENT
Credential: CCP, LCP
Phone: 901-210-4258