Provider Demographics
NPI:1477754505
Name:GIPSON SPECIALTY CENTER, PLLC
Entity Type:Organization
Organization Name:GIPSON SPECIALTY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-767-9500
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-767-9500
Mailing Address - Fax:901-767-7324
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-767-9500
Practice Address - Fax:901-767-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4079656OtherBLUE CROSS OF TN
125345900OtherU.S. DEPT. OF LABOR
4226549OtherAETNA
TN3011025Medicare ID - Type UnspecifiedINDIVIDUAL PTAN (PIN)
TN3724471Medicare ID - Type UnspecifiedGROUP BILLING #