Healthcare Provider Details

I. General information

NPI: 1285211623
Provider Name (Legal Business Name): MEMPHIS VASCULAR SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MURRAY AVE
MEMPHIS TN
38119-3831
US

IV. Provider business mailing address

26500 AGOURA RD STE 102-587
CALABASAS CA
91302-1952
US

V. Phone/Fax

Practice location:
  • Phone: 901-633-1190
  • Fax: 901-881-7979
Mailing address:
  • Phone: 818-880-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0106X
TaxonomyVascular-Interventional Technology Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK RABINOVICH
Title or Position: MANAGER
Credential:
Phone: 818-880-8605