Provider Demographics
NPI:1669628467
Name:MEMPHIS MULTI SPECIALTY ASSOCIATES,LLC
Entity Type:Organization
Organization Name:MEMPHIS MULTI SPECIALTY ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-384-9920
Mailing Address - Street 1:7865 EDUCATORS LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-8191
Mailing Address - Country:US
Mailing Address - Phone:901-384-9920
Mailing Address - Fax:901-937-7879
Practice Address - Street 1:3960 KNIGHT ARNOLD RD STE 108
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3001
Practice Address - Country:US
Practice Address - Phone:901-369-6000
Practice Address - Fax:901-369-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35471207R00000X
TN38037207RI0011X
TN41376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty