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NPI Code Detail

MEDICARE: PEDIATRIC EMERGENCY SPECIALISTS, PC

MEDICARE: PEDIATRIC EMERGENCY SPECIALISTS, PC
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
1207PP0204XPediatric Emergency Medicine (Emergency Medicine) PhysicianN/ATN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760482434
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC EMERGENCY SPECIALISTS, PC
Provider Business Mailing Address
First Line : 5885 AIRLINE RD
Second Line : #1011
City : ARLINGTON
State : TN
Zip : 38002-5127
Country : US
Telephone Number : 901-317-7360
Fax Number : 901-317-7585
Provider Business Practice Location Address
First Line : 848 ADAMS AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38103-2816
Country : US
Telephone Number : 901-287-6112
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. WILLIAM R HANNA JR.
Credential : MD
Telephone Number : 901-287-6112
Provider Enumeration Date : 07/26/2005
Last Update Date : 01/03/2015

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1437159126 — DR. BARRY G GILMORE MD
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1093715682 — DR. WILLIAM R HANNA JR. MD
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1528068962 — DR. JOSEPH V POLLACK MD
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