Provider Demographics
NPI:1417001223
Name:DAVID L. SIMMONS, MD, PC - CARDIOVASCULAR SERVICES
Entity Type:Organization
Organization Name:DAVID L. SIMMONS, MD, PC - CARDIOVASCULAR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-482-0988
Mailing Address - Street 1:PO BOX 341127
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38184-1127
Mailing Address - Country:US
Mailing Address - Phone:901-482-0988
Mailing Address - Fax:901-767-5213
Practice Address - Street 1:202 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-3237
Practice Address - Country:US
Practice Address - Phone:901-482-0988
Practice Address - Fax:901-767-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15027207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00011350Medicaid
MS00011350Medicaid