Healthcare Provider Details

I. General information

NPI: 1871711341
Provider Name (Legal Business Name): ASC MEMPHIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 S YATES RD
MEMPHIS TN
38119-0882
US

IV. Provider business mailing address

111 S HIGHLAND ST # 413
MEMPHIS TN
38111-4640
US

V. Phone/Fax

Practice location:
  • Phone: 901-681-9820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS NICHOLS
Title or Position: AR DIRECTOR
Credential:
Phone: 586-498-9440