Provider Demographics
NPI:1407981467
Name:MEMPHIS SURGICAL SPECIALISTS, PC
Entity Type:Organization
Organization Name:MEMPHIS SURGICAL SPECIALISTS, PC
Other - Org Name:RAZA A. DILAWARI, M.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUNSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-382-3333
Mailing Address - Street 1:3950 NEW COVINGTON PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2595
Mailing Address - Country:US
Mailing Address - Phone:901-382-3333
Mailing Address - Fax:901-382-5153
Practice Address - Street 1:3950 NEW COVINGTON PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2595
Practice Address - Country:US
Practice Address - Phone:901-382-3333
Practice Address - Fax:901-382-5153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3384664Medicaid
TN3898079Medicaid
TN3384664Medicaid
TN3898079Medicaid