Provider Demographics
NPI:1760687297
Name:SUTHERLAND CARDIOLOGY CLINIC, P.C.
Entity Type:Organization
Organization Name:SUTHERLAND CARDIOLOGY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MSA
Authorized Official - Phone:901-763-0200
Mailing Address - Street 1:7460 WOLF RIVER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-763-0200
Mailing Address - Fax:901-276-4128
Practice Address - Street 1:5959 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5200
Practice Address - Country:US
Practice Address - Phone:901-763-0200
Practice Address - Fax:901-276-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3379449Medicare ID - Type Unspecified