Provider Demographics
NPI:1730449232
Name:ENDOCRINOLOGY AND DIABETES SPECIALISTS, LLC
Entity type:Organization
Organization Name:ENDOCRINOLOGY AND DIABETES SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-756-5565
Mailing Address - Street 1:PO BOX 2044 DEPT 6000
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-2022
Mailing Address - Country:US
Mailing Address - Phone:901-348-6487
Mailing Address - Fax:901-791-0338
Practice Address - Street 1:7796 WOLF TRAIL CV STE 201
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1781
Practice Address - Country:US
Practice Address - Phone:901-348-6487
Practice Address - Fax:901-791-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4327373OtherBCBS
TNDS8846OtherRAILROAD MEDICARE
TN103G703233Medicare PIN