Provider Demographics
NPI:1659485761
Name:EAST MEMPHIS NEONATOLOGY ASSOCIATES P.C
Entity Type:Organization
Organization Name:EAST MEMPHIS NEONATOLOGY ASSOCIATES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-747-0291
Mailing Address - Street 1:6215 HUMPHREYS BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2382
Mailing Address - Country:US
Mailing Address - Phone:901-747-0291
Mailing Address - Fax:901-747-0299
Practice Address - Street 1:6215 HUMPHREYS BLVD STE 310
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2382
Practice Address - Country:US
Practice Address - Phone:901-747-0291
Practice Address - Fax:901-747-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155721002Medicaid
MS9013621Medicaid
AR96783OtherBLUE CROSS ARKANSAS