Provider Demographics
NPI:1497711998
Name:ANESTHESIA ASSOCIATES OF MEMPHIS, INC.
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF MEMPHIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:ISOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:901-797-9711
Mailing Address - Street 1:PO BOX 382693
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-2693
Mailing Address - Country:US
Mailing Address - Phone:901-797-9711
Mailing Address - Fax:901-797-9771
Practice Address - Street 1:5744 NANJACK CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2061
Practice Address - Country:US
Practice Address - Phone:901-797-9711
Practice Address - Fax:901-797-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3703379Medicare PIN
TN3621329Medicare PIN