Provider Demographics
NPI:1730153073
Name:EAST MEMPHIS UROLOGY CENTER, LP
Entity type:Organization
Organization Name:EAST MEMPHIS UROLOGY CENTER, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-747-3370
Mailing Address - Street 1:80 HUMPHREYS CTR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2353
Mailing Address - Country:US
Mailing Address - Phone:901-747-3370
Mailing Address - Fax:901-747-3372
Practice Address - Street 1:80 HUMPHREYS CTR
Practice Address - Street 2:SUITE 310
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2353
Practice Address - Country:US
Practice Address - Phone:901-747-3370
Practice Address - Fax:901-747-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000122261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3146732OtherBCBS PROVIDER NUMBER
TN3288203Medicare ID - Type UnspecifiedPROVIDER NUMBER