Provider Demographics
NPI:1942498167
Name:THE MEMPHIS TN ENDOSCOPY ASC LLC
Entity Type:Organization
Organization Name:THE MEMPHIS TN ENDOSCOPY ASC LLC
Other - Org Name:MEDICAL CENTER ENDOSCOPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANGER OF LLC
Authorized Official - Prefix:MRS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:80 HUMPHREYS CTR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2353
Mailing Address - Country:US
Mailing Address - Phone:901-578-3900
Mailing Address - Fax:901-578-2572
Practice Address - Street 1:80 HUMPHREYS CTR
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2353
Practice Address - Country:US
Practice Address - Phone:901-578-3900
Practice Address - Fax:901-578-2572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00882OtherRAILROAD
TN3287008Medicare PIN