SOUTHERN CARDIOVASCULAR PLLC (NPI# 1447415104) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447415104 |
| Entity Type | Organization |
| Organization Name | SOUTHERN CARDIOVASCULAR PLLC |
| Practice Address |
6401 Poplar Ave Ste 410 Memphis TN 38119 |
| Mailing Address |
Po Box 1135 Collierville TN 38027-1135 |
| Practice Telephone | 9012592718 |
| Practice Fax Number | 9012591123 |
| Mailing Telephone | 9012592718 |
| Mailing Fax Number | 9012591123 |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2018-08-15 |
| Authorized Official Name | DR. JONATHAN JOE ELLICHMAN (PRESIDENT) |
| Authorized Official Telephone | 9012592718 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 1526038 | 05 |
| Street Address |
6401 POPLAR AVE STE 410 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073538823 | Jonathan J Ellichman | Surgery | 6401 Poplar Ave Ste 410, Memphis, TN 38119-4808 | 2006-07-13 |
| 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 | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952914285 | Methodist Physician Practice LLC | Clinic/Center | 1211 Union Ave Ste 330, Memphis, TN 38104-6655 | 2020-08-26 |
| 1831721208 | Patientchoicemd, LLC | Clinic/Center | 3274 Wind Shadow Cv, Memphis, TN 38125-0773 | 2020-02-04 |
| 1316427602 | Chs Tennessee Medical P C | Clinic/Center | 2680 Pershing Ave, Memphis, TN 38112 | 2018-08-16 |
| 1275073801 | Chs Tennessee Medical PC | Clinic/Center | 5106 Tradeport Dr, Memphis, TN 38141-8235 | 2017-03-01 |
| 1780073270 | Whole Health Medical Group Ohio Professional Corporation | Clinic/Center | 3140 Tchulahoma Rd, Suite 1-4, Memphis, TN 38118-2722 | 2015-01-21 |
| 1518143692 | University of Memphis | Clinic/Center | 119 Patterson Hall, Main Office, Memphis, TN 38152-3510 | 2008-01-18 |
| 1144851858 | Chs Tennessee Medical P C | Clinic/Center | 262 Danny Thomas Pl, Memphis, TN 38105-3678 | 2020-01-31 |
| 1154793727 | Your Community Health & Wellness | Clinic/Center | 1087 Alice Ave, Memphis, TN 38106-6543 | 2015-10-22 |
| 1700276169 | Whole Health Medical Group Ohio Professional Corporation | Clinic/Center | 3145 Players Club Pkwy, Memphis, TN 38125-8835 | 2015-01-23 |
| 1831320076 | Memphis Tr Centers, Pllc | Clinic/Center | 995 S Yates Rd, Suite 1, Memphis, TN 38119-0882 | 2009-08-06 |
| 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.