Provider Demographics
NPI:1427224856
Name:MAIC PC
Entity Type:Organization
Organization Name:MAIC PC
Other - Org Name:MEMPHIS ACCIDENT AND INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-649-4662
Mailing Address - Street 1:PO BOX 7461
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468
Mailing Address - Country:US
Mailing Address - Phone:561-649-4662
Mailing Address - Fax:561-649-4665
Practice Address - Street 1:1509 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-278-5156
Practice Address - Fax:901-278-5161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1470111N00000X
TNAPN0000005344208100000X
TN11736208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty