Provider Demographics
NPI:1811442452
Name:IDEAL HEALTH SOLUTIONS, LLC
Entity type:Organization
Organization Name:IDEAL HEALTH SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BURFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-853-1734
Mailing Address - Street 1:346 NEW BYHALIA RD STE 3
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3741
Mailing Address - Country:US
Mailing Address - Phone:901-853-1734
Mailing Address - Fax:
Practice Address - Street 1:346 NEW BYHALIA RD STE 3
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3741
Practice Address - Country:US
Practice Address - Phone:901-853-1734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35915208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty