=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053362749
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEMPHIS CARDIAC CARE CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2006
-----------------------------------------------------
Last Update Date | 12/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 EASTMORELAND AVE SUITE 440
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38104-3519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-722-8884
-----------------------------------------------------
Fax | 901-276-1436
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 381588
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38183-1588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-722-8884
-----------------------------------------------------
Fax | 901-276-1436
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SUNIL JHA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 901-722-8884
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0001X
-----------------------------------------------------
Taxonomy Name | Clinical Cardiac Electrophysiology Physician
-----------------------------------------------------
License Number | MD0000035150
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------