Healthcare Provider Details

I. General information

NPI: 1760408801
Provider Name (Legal Business Name): AMISUB (SFH), INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE
MEMPHIS TN
38119-5200
US

IV. Provider business mailing address

PO BOX 676757
DALLAS TX
75267-6757
US

V. Phone/Fax

Practice location:
  • Phone: 901-765-1000
  • Fax:
Mailing address:
  • Phone: 678-242-2002
  • Fax: 504-365-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number0000000111
License Number StateTN

VIII. Authorized Official

Name: RYAN NELSON
Title or Position: CFO
Credential:
Phone: 901-765-1000