Provider Demographics
NPI:1235183674
Name:CALLAN, ERIC W (CRNA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:CALLAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 PLAYERS CLUB PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8949
Mailing Address - Country:US
Mailing Address - Phone:901-844-1590
Mailing Address - Fax:901-844-1592
Practice Address - Street 1:3340 PLAYERS CLUB PKWY STE 350
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125
Practice Address - Country:US
Practice Address - Phone:901-844-1590
Practice Address - Fax:901-844-1592
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96993367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4047282OtherBLUE CROSS
TN3631779Medicaid
MS01806237Medicaid
430076020OtherRAILROAD MEDICARE
TN3631779Medicare PIN