MEDICARE: EDUARDO VIRTUCIO BASCO MD

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	207RC0000X	Cardiovascular Disease Physician	16975	MS
2	207RC0000X	Cardiovascular Disease Physician	31561	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4270156	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1750381430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO VIRTUCIO BASCO MD

Provider Business Mailing Address
First Line	:	1211 UNION AVE STE 330
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-6655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 NEW COVINGTON PIKE STE 220
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2595
Country	:	US
Telephone Number	:	901-763-0200
Fax Number	:	901-761-4002

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	05/17/2024

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Directions to “ EDUARDO VIRTUCIO BASCO MD” Practice Location

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