Provider Demographics
NPI:1740470863
Name:PHOENIX NEUROSURGERY, PLLC
Entity type:Organization
Organization Name:PHOENIX NEUROSURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PURIFOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-276-6453
Mailing Address - Street 1:5673 S REX RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3821
Mailing Address - Country:US
Mailing Address - Phone:901-276-6400
Mailing Address - Fax:901-276-6440
Practice Address - Street 1:5673 S REX RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3821
Practice Address - Country:US
Practice Address - Phone:901-276-6400
Practice Address - Fax:901-276-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3075466OtherMEDICARE ID
TNF61436Medicare PIN