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NPI Code Detail

MEDICARE: ALEC SISCO

MEDICARE: ALEC SISCO
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
1390200000XStudent in an Organized Health Care Education/Training ProgramTN

General Provider Information

NPI Number : 1588591366
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEC SISCO
Provider Business Mailing Address
First Line : 3526 PHILWOOD AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38122-4556
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3720 ALUMNI AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-5914
Country : US
Telephone Number : 901-297-3119
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2026
Last Update Date : 05/06/2026

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Directions to “ ALEC SISCO ” Practice Location

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