Provider Demographics
NPI:1578620803
Name:THE HEART CENTER OF MEMPHIS PLLC
Entity Type:Organization
Organization Name:THE HEART CENTER OF MEMPHIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-821-0338
Mailing Address - Street 1:PO BOX 2044
Mailing Address - Street 2:DEPT 4300
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-2044
Mailing Address - Country:US
Mailing Address - Phone:901-507-6600
Mailing Address - Fax:901-507-6599
Practice Address - Street 1:1211 UNION AVE
Practice Address - Street 2:SUITE 495
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6638
Practice Address - Country:US
Practice Address - Phone:901-507-6600
Practice Address - Fax:901-507-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028889207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723803Medicaid
TNF37590Medicare UPIN
TN3723803Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER