=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619487782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRESENIUS ACCESS CARE PHYSICIANS OF MEMPHIS ASC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2017
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6490 MT MORIAH RD EXT STE 202
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38115-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-366-5479
-----------------------------------------------------
Fax | 901-366-5484
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | DEPT 192, PO BOX 1000
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38148-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-644-8900
-----------------------------------------------------
Fax | 484-924-5300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | DR. GREGG MILLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 717-515-4048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------