MEDICARE: MR. MARCHICA TERRELL PARRAM CSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist
2	246ZS0410X	Surgical Technologist	3681	TN

General Provider Information

NPI Number	:	1407149776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCHICA TERRELL PARRAM CSA

Provider Business Mailing Address
First Line	:	PO BOX 34162
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38184-0162
Country	:	US
Telephone Number	:	901-239-1124
Fax Number	:

Provider Business Practice Location Address
First Line	:	5157 PATRICK HENRY DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-2906
Country	:	US
Telephone Number	:	901-239-1124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	07/17/2014

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