=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801264510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGICAL ASSOCIATES OF MEMPHIS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2015
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1286 PEABODY AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38104-3550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-276-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1286 PEABODY AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38104-3550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-276-6000
-----------------------------------------------------
Fax | 901-276-4000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RODNEY A MARTIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 901-276-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MD019088
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------