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NPI Code Detail

MEDICARE: DAR SALUD CARE PLLC

MEDICARE: DAR SALUD CARE PLLC
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
1207RC0000XCardiovascular Disease Physician
2207RE0101XEndocrinology, Diabetes & Metabolism Physician
32080N0001XNeonatal-Perinatal Medicine Physician
4363AM0700XMedical Physician Assistant
5363LF0000XFamily Nurse Practitioner
6363LP0808XPsychiatric/Mental Health Nurse Practitioner
7152W00000XOptometrist
8207R00000XInternal Medicine Physician
93336C0002XClinic Pharmacy
10207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12158680OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598018806
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAR SALUD CARE PLLC
Provider Business Mailing Address
First Line : 6074 APPLE TREE DR STE 10
Second Line :
City : MEMPHIS
State : TN
Zip : 38115-0300
Country : US
Telephone Number : 901-922-5951
Fax Number : 901-922-5952
Provider Business Practice Location Address
First Line : 1068 CRESTHAVEN RD STE 300
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-0809
Country : US
Telephone Number : 901-683-0024
Fax Number : 901-683-0086
Authorized Official
Title or Position : BILLING AND CREDENTIALING MANAGER
Name : ANDREA FULLER
Credential : MAML
Telephone Number : 901-922-5951
Provider Enumeration Date : 10/24/2012
Last Update Date : 04/06/2020

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