Organization
CENTROSALUD PC
Active
Other names
LifeDOC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DWIGHT B COWAN (COO)
(901) 531-8800
Entity
Organization
Contact information
Practice address
1068 CRESTHAVEN RD, SUITE 300, MEMPHIS, TN 38119-0800
(901) 683-0024
(901) 683-0028
Mailing address
6063 MOUNT MORIAH ROAD EXT, SUITE 4, MEMPHIS, TN 38115-2644
(901) 531-8800
(901) 531-8801
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD000035089
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3728771
MEDICARE PROVIDER NUMBER
TN
Enumeration date
02/20/2007
Last updated
08/17/2010
Update your record
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