Provider Demographics
NPI:1548235104
Name:MEMPHIS HEART CLINIC
Entity Type:Organization
Organization Name:MEMPHIS HEART CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSPEH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAMAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-818-0300
Mailing Address - Street 1:6025 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2131
Mailing Address - Country:US
Mailing Address - Phone:901-818-0300
Mailing Address - Fax:901-818-0458
Practice Address - Street 1:6025 WALNUT GROVE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2131
Practice Address - Country:US
Practice Address - Phone:901-818-0300
Practice Address - Fax:901-818-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCI8707OtherRRMC
MS09015177Medicaid
MSCG7819OtherRRMC
MSC02523Medicare ID - Type Unspecified
TNCI8707OtherRRMC