Provider Demographics
NPI:1184765497
Name:ASSOCIATED UROLOGISTS OF MEMPHIS PC
Entity type:Organization
Organization Name:ASSOCIATED UROLOGISTS OF MEMPHIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-527-7100
Mailing Address - Street 1:995 S YATES RD
Mailing Address - Street 2:STE. 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0882
Mailing Address - Country:US
Mailing Address - Phone:901-527-7100
Mailing Address - Fax:901-527-7124
Practice Address - Street 1:995 S YATES RD
Practice Address - Street 2:STE. 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0882
Practice Address - Country:US
Practice Address - Phone:901-527-7100
Practice Address - Fax:901-527-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3371822Medicaid
TN3371822Medicare ID - Type UnspecifiedTENNESSEE MEDICARE
TN3371822Medicaid