Healthcare Provider Details

I. General information

NPI: 1033381397
Provider Name (Legal Business Name): GREGORY PIGGS SR. CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7324 SOUTHWEST FWY STE 1550
HOUSTON TX
77074-2053
US

IV. Provider business mailing address

5210 POPLAR SUITE 200
MEMPHIS TN
38119
US

V. Phone/Fax

Practice location:
  • Phone: 901-297-5756
  • Fax:
Mailing address:
  • Phone: 901-682-9161
  • Fax: 901-767-9584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number2966
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: