Provider Demographics
NPI:1407615677
Name:RADIANT LIFE HEALTHCARE PC
Entity Type:Organization
Organization Name:RADIANT LIFE HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-582-4059
Mailing Address - Street 1:1072 WEDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-8138
Mailing Address - Country:US
Mailing Address - Phone:901-582-4059
Mailing Address - Fax:901-726-2001
Practice Address - Street 1:333 S BELLEVUE BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3530
Practice Address - Country:US
Practice Address - Phone:901-729-2708
Practice Address - Fax:901-729-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty