Provider Demographics
NPI:1528443207
Name:PEDIATRIC ANESTHESIOLOGISTS PA
Entity type:Organization
Organization Name:PEDIATRIC ANESTHESIOLOGISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MOHANDAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KARKERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-287-6060
Mailing Address - Street 1:PO BOX 5099
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-5099
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 N DUNLAP ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2800
Practice Address - Country:US
Practice Address - Phone:901-287-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty