Provider Demographics
NPI:1386628329
Name:MEMPHIS ORTHOPAEDIC GROUP PC
Entity Type:Organization
Organization Name:MEMPHIS ORTHOPAEDIC GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-3232
Mailing Address - Street 1:3980 NEW COVINGTON PIKE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2500
Mailing Address - Country:US
Mailing Address - Phone:901-382-2606
Mailing Address - Fax:901-373-0809
Practice Address - Street 1:3980 NEW COVINGTON PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2500
Practice Address - Country:US
Practice Address - Phone:901-382-2606
Practice Address - Fax:901-373-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3388237Medicare ID - Type Unspecified
TN0440940002Medicare NSC
TN3388235Medicare ID - Type Unspecified
TN0440940004Medicare NSC
TN0440940003Medicare NSC
TN0440940001Medicare NSC
TN3388239Medicare ID - Type Unspecified
TN3388238Medicare ID - Type Unspecified
TNCC4987Medicare ID - Type UnspecifiedRR
TN3388236Medicare ID - Type Unspecified