Healthcare Provider Details

I. General information

NPI: 1972288157
Provider Name (Legal Business Name): ELENA SAVAGE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 UNION AVE STE 300
MEMPHIS TN
38104-6655
US

IV. Provider business mailing address

PO BOX 27892
BELFAST ME
04915-2030
US

V. Phone/Fax

Practice location:
  • Phone: 901-272-6018
  • Fax: 901-201-4203
Mailing address:
  • Phone: 901-758-9900
  • Fax: 901-752-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5600
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: