Organization
MEMPHIS SPINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSI COOPER (OFFICE MANAGER)
(901) 507-2225
Entity
Organization
Contact information
Practice address
2120 EXETER RD, SUITE 130, GERMANTOWN, TN 38138-3922
(901) 507-2225
(901) 507-7890
Mailing address
2120 EXETER RD, SUITE 130, GERMANTOWN, TN 38138-3900
(901) 507-2225
(901) 507-7890
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4092713
BLUE CROSS BLUE SHIELD
TN
01
—
5305190001
CIGNA GOVERNMENT SERVICES
TN
Enumeration date
06/23/2006
Last updated
02/27/2008
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