Provider Demographics
NPI:1245242817
Name:SOUTHWIND ENDOSCOPY CENTER
Entity Type:Organization
Organization Name:SOUTHWIND ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-367-9001
Mailing Address - Street 1:3725 CHAMPION HILLS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2597
Mailing Address - Country:US
Mailing Address - Phone:901-367-9001
Mailing Address - Fax:
Practice Address - Street 1:3725 CHAMPION HILLS DR
Practice Address - Street 2:#2000
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2597
Practice Address - Country:US
Practice Address - Phone:901-367-9001
Practice Address - Fax:901-565-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3288890Medicare PIN