Provider Demographics
NPI:1922634575
Name:DEDICATED PHYSICIANS GROUP OF TENNESSEE, PLLC
Entity Type:Organization
Organization Name:DEDICATED PHYSICIANS GROUP OF TENNESSEE, PLLC
Other - Org Name:DEDICATED SENIOR MEDICAL CENTER LAMAR AIRWAYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-628-6117
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2252 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114-6608
Practice Address - Country:US
Practice Address - Phone:901-671-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEDICATED PHYSICIANS GROUP OF TENNESSEE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-16
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site