Provider Demographics
NPI:1740251396
Name:PEDIATRIC CONSULTANTS, P.C.
Entity type:Organization
Organization Name:PEDIATRIC CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PEDIATRIC CONSULTANTS, P
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:FRIZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-523-2945
Mailing Address - Street 1:777 WASHINGTON AVENUE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105
Mailing Address - Country:US
Mailing Address - Phone:901-523-2945
Mailing Address - Fax:901-523-8488
Practice Address - Street 1:777 WASHINGTON AVENUE
Practice Address - Street 2:SUITE 410
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-523-2945
Practice Address - Fax:901-523-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702682Medicaid
TN3702682Medicaid