Provider Demographics
NPI:1760482434
Name:PEDIATRIC EMERGENCY SPECIALISTS, PC
Entity Type:Organization
Organization Name:PEDIATRIC EMERGENCY SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:901-287-6112
Mailing Address - Street 1:5885 AIRLINE RD
Mailing Address - Street 2:#1011
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-5127
Mailing Address - Country:US
Mailing Address - Phone:901-317-7360
Mailing Address - Fax:901-317-7585
Practice Address - Street 1:848 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2816
Practice Address - Country:US
Practice Address - Phone:901-287-6112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNN/A207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3379568Medicaid
TN3379568Medicare PIN