Provider Demographics
NPI:1770895591
Name:METHODIST SPECIALTY PHYSICIAN VI
Entity type:Organization
Organization Name:METHODIST SPECIALTY PHYSICIAN VI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SHARIF
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDUS-SALAAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-421-5138
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 970
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-1000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1264 WESLEY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6400
Practice Address - Country:US
Practice Address - Phone:901-260-2072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHODIST HEALTHCARE PRIMARY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-09
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty