MEDICARE: BEHAVIORAL MEDICINE CONSULTANTS, 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
1	2084P0800X	Psychiatry Physician	25198	TN

General Provider Information

NPI Number	:	1689813057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL MEDICINE CONSULTANTS, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 770875
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38177-0875
Country	:	US
Telephone Number	:	901-255-3030
Fax Number	:	901-507-7811

Provider Business Practice Location Address
First Line	:	5384 POPLAR AVE
Second Line	:	STE 106
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3609
Country	:	US
Telephone Number	:	901-255-3030
Fax Number	:	901-507-7811

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS G BANNISTER
Credential	:	MD
Telephone Number	:	901-255-3030

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	02/09/2009

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