Provider Demographics
NPI:1609022839
Name:PHYSICIANS OF HEARTS P.L.L.C.
Entity Type:Organization
Organization Name:PHYSICIANS OF HEARTS P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-682-7241
Mailing Address - Street 1:6005 PARK AVE STE 702
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5217
Mailing Address - Country:US
Mailing Address - Phone:901-682-7241
Mailing Address - Fax:901-682-7243
Practice Address - Street 1:6005 PARK AVE STE 702
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5217
Practice Address - Country:US
Practice Address - Phone:901-682-7241
Practice Address - Fax:901-682-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511374Medicaid
TNG30163OtherUPIN
TNG30163OtherUPIN