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General NPI Number Information
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NPI Number | 1730153073
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Entity Type | Organization
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Legal Business Name | EAST MEMPHIS UROLOGY CENTER, LP
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 80 HUMPHREYS CTR SUITE 310
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City | MEMPHIS
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State | TN
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Zip | 38120-2353
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Country | US
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Telephone | 901-747-3370
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Fax | 901-747-3372
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Provider Business Mailing Address
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Address Line | 80 HUMPHREYS CTR SUITE 310
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City | MEMPHIS
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State | TN
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Zip | 38120-2353
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Country | US
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Telephone | 901-747-3370
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Fax | 901-747-3372
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RICKY ALLEN SMITH
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Credential | M.D.
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Telephone | 901-747-3370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0000000122
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License Number State | TN
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