CENTROSALUD PC (NPI# 1003951963) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003951963 |
| Entity Type | Organization |
| Organization Name | CENTROSALUD PC |
| Other Organization Name | LIFEDOC |
| Practice Address |
1068 Cresthaven Rd Suite 300 Memphis TN 38119-0800 |
| Mailing Address |
6063 Mount Moriah Road Ext Suite 4 Memphis TN 38115-2644 |
| Practice Telephone | 9016830024 |
| Practice Fax Number | 9016830028 |
| Mailing Telephone | 9015318800 |
| Mailing Fax Number | 9015318801 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2010-08-17 |
| Authorized Official Name | MR. DWIGHT B COWAN (COO) |
| Authorized Official Telephone | 9015318800 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | MD000035089 | TN | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | MEDICARE PROVIDER NUMBER | 3728771 | 01 |
| Other Name | Type Code |
|---|---|
| LifeDOC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477786473 | Centrosalud PC | Pediatrics | 2900 Kirby Road, Suite #11, Memphis, TN 38119 | 2009-08-25 |
| 1205036951 | Centrosalud PC | Internal Medicine | 6063 Mount Moriah Road Ext, Suite 4, Memphis, TN 38115-2644 | 2007-07-20 |
| Street Address |
1068 CRESTHAVEN RD SUITE 300 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38119-0800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457354599 | Charlotte A Deflumere | Internal Medicine | 1068 Cresthaven Rd, Suite 110, Memphis, TN 38119-0800 | 2005-05-23 |
| 1881193035 | Walid Amin Mohammad | Pharmacist | 1068 Cresthaven Rd, Memphis, TN 38119-0800 | 2018-02-02 |
| 1972059491 | Desiree Shammas | Nurse Anesthetist, Certified Registered | 1068 Cresthaven Rd, Suite 150, Memphis, TN 38119-0800 | 2016-08-26 |
| 1942754635 | Richard Dawson Holloway IIi | Nurse Practitioner | 1068 Cresthaven Rd, Memphis, TN 38119-0800 | 2016-08-10 |
| 1750834123 | Andrea Baker | Nurse Anesthetist, Certified Registered | 1068 Cresthaven Rd, Suite 150, Memphis, TN 38119-0800 | 2016-08-02 |
| 1639522154 | Haleigh Sligar | Nurse Anesthetist, Certified Registered | 1068 Cresthaven Rd, Suite 150, Memphis, TN 38119-0800 | 2016-07-20 |
| 1972952976 | Dar Salud Care Pllc | Pharmacy | 1068 Cresthaven Rd, Suite 300, Memphis, TN 38119-0800 | 2016-06-09 |
| 1417365156 | Veronica Sanders | Registered Nurse | 1068 Cresthaven Rd, Suite 100, Memphis, TN 38119-0800 | 2014-07-25 |
| 1952712796 | For Sight Eye Care, LLC | Optometrist | 1068 Cresthaven Rd, 300, Memphis, TN 38119-0800 | 2014-05-14 |
| 1649681610 | Magen Mcculloch | Nurse Anesthetist, Certified Registered | 1068 Cresthaven Rd, Suite 150, Memphis, TN 38119-0800 | 2014-05-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417469628 | Jojuan Fullwiley | Behavioral Analyst | 6685 Quince Rd Ste 116, Memphis, TN 38119 | 2017-10-27 |
| 1336675297 | Jill Budynas Depriest | Counselor | 5583 Murray Ave Ste 203, Memphis, TN 38119 | 2017-05-11 |
| 1396279220 | Glen Matthew Stamps Jr. | Counselor | 5583 Murray Ave Ste 207, Memphis, TN 38119 | 2017-04-18 |
| 1598117442 | Hazel Aberdeen | Chiropractor | 1911 Memphis Tennessee, Memphis, TN 38119 | 2016-07-04 |
| 1831569060 | E-c-t Non Emergency Medical Transport | Non-emergency Medical Transport (VAN) | 6869 Woodlake Dr, Memphis, TN 38119 | 2015-09-30 |
| 1053781617 | Astrid Roman | Dietitian, Registered | 8020 Hillside Cv, Memphis, MS 38119 | 2015-09-25 |
| 1467857664 | Allan Jacob Katz | Counselor | 5668 Rex Rd, Suite 104, Memphis, TN 38119 | 2014-10-30 |
| 1962836015 | Judy Ann Harrick | Acupuncturist | 5575 Poplar Ave., #702, Memphis, TN 38119 | 2013-08-26 |
| 1366791949 | Jennifer Denyes Bidelman | Audiologist | 5625 Poplar Avenue, Memphis, TN 38119 | 2012-08-29 |
| 1578833620 | Elizabeth Mary Dion-douglass | Pharmacist | 2891 Kirby Parkway, Memphis, TN 38119 | 2012-01-06 |
| Find all providers in zip 38119 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487270963 | Daphne Hall | Specialist | 2504 Mount Moriah Rd Bldg D, Memphis, TN 38115-1519 | 2020-06-22 |
| 1013481597 | Tiffany Powell | Specialist | 679 S Mendenhall Rd, Memphis, TN 38117-5212 | 2019-01-17 |
| 1245735067 | Xclusive Kutz Barbershop | Specialist | 3610 Park Ave, Memphis, TN 38111-5630 | 2018-03-25 |
| 1033582267 | Aletta Roebuck | Specialist | 2275 Edgewood Cv, Memphis, TN 38104-4357 | 2015-11-10 |
| 1922482967 | Convalescent Home Health Services | Specialist | 2904 Chelsea Ave, Memphis, TN 38108-1705 | 2015-07-18 |
| 1821407859 | Rachel Siegel | Specialist | 430 Essex Pl, Memphis, TN 38120-2422 | 2014-08-04 |
| 1790199180 | Supplemental Specialists | Specialist | 7665 Easterly Ln, Memphis, TN 38125-4313 | 2014-06-13 |
| 1982027769 | Dowen E Synder | Specialist | 6224 Shady Grove Ln, Memphis, TN 38120-3107 | 2014-01-29 |
| 1962845503 | Atlas Health, Pllc | Specialist | 14 N Mclean Blvd, Memphis, TN 38104-2645 | 2013-04-13 |
| 1760725659 | Jyothishree PC | Specialist | 6005 Park Ave Ste 626b, Memphis, TN 38119-5221 | 2013-03-29 |
| Find all providers in MEMPHIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.