Provider Demographics
NPI:1053362749
Name:MEMPHIS CARDIAC CARE CENTER, PLLC
Entity type:Organization
Organization Name:MEMPHIS CARDIAC CARE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-722-8884
Mailing Address - Street 1:PO BOX 381588
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1588
Mailing Address - Country:US
Mailing Address - Phone:901-722-8884
Mailing Address - Fax:901-276-1436
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-722-8884
Practice Address - Fax:901-276-1436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000035150207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3863065Medicaid
MS00124374Medicaid
TN3863065Medicaid
TNH34649Medicare UPIN