Provider Demographics
NPI:1366643355
Name:EAST MEMPHIS ELECTROGARDIOGRAPHERS ASSOCIATION, LLC
Entity Type:Organization
Organization Name:EAST MEMPHIS ELECTROGARDIOGRAPHERS ASSOCIATION, LLC
Other - Org Name:EAST MEMPHIS EKG ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPIOTTA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:901-821-0338
Mailing Address - Street 1:PO BOX 241926
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38124-1926
Mailing Address - Country:US
Mailing Address - Phone:901-821-0338
Mailing Address - Fax:901-821-0341
Practice Address - Street 1:5959 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5200
Practice Address - Country:US
Practice Address - Phone:901-821-0338
Practice Address - Fax:901-821-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMDTDL0451207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB00968Medicare UPIN
TN3386204Medicare PIN
TN3117697Medicare PIN