Provider Demographics
NPI:1730142795
Name:CARDIOVASCULAR SPECIALIST , P.C.
Entity Type:Organization
Organization Name:CARDIOVASCULAR SPECIALIST , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-722-0340
Mailing Address - Street 1:MSC 410702
Mailing Address - Street 2:P O BOX 415000
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37241-0001
Mailing Address - Country:US
Mailing Address - Phone:901-722-0340
Mailing Address - Fax:
Practice Address - Street 1:1211 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6643
Practice Address - Country:US
Practice Address - Phone:901-722-0340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND320912086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3849165Medicaid
TN3378751Medicare ID - Type UnspecifiedMCR GROUP #