Provider Demographics
NPI:1073624995
Name:MEMPHIS EMERGENCY SPECIALISTS PC
Entity Type:Organization
Organization Name:MEMPHIS EMERGENCY SPECIALISTS PC
Other - Org Name:SOUTHERN FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:ZANONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-342-4080
Mailing Address - Street 1:6426 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-2474
Mailing Address - Country:US
Mailing Address - Phone:662-342-4080
Mailing Address - Fax:662-342-4933
Practice Address - Street 1:6426 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-2474
Practice Address - Country:US
Practice Address - Phone:662-342-4080
Practice Address - Fax:662-342-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS6971261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB03608Medicare UPIN
MSC02946Medicare PIN
MS0878990001Medicare NSC