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General NPI Number Information
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NPI Number | 1134472384
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Entity Type | Organization
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Legal Business Name | THE LUNG CLINIC LLC
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 6019 WALNUT GROVE RD.
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City | MEMPHIS
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State | TN
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Zip | 38120-0000
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Country | US
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Telephone | 901-753-8361
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Fax | 901-756-8541
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Provider Business Mailing Address
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Address Line | PO BOX 440107
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City | NASHVILLE
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State | TN
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Zip | 37244-0107
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Country | US
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Telephone | 901-753-8361
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Fax | 901-756-8541
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANJAY RATNAKANT
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Credential | MD
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Telephone | 901-753-8361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 39269
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 39269
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 39269
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License Number State | TN
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