Organization
UT REGIONAL ONE PHYSICIANS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDOLPH SITES III (EXECUTIVE DIRECTOR)
(901) 545-7125
Entity
Organization
Contact information
Practice address
877 JEFFERSON AVE, MEMPHIS, TN 38103-2807
(901) 545-8336
(901) 545-8122
Mailing address
877 JEFFERSON AVE, ATTN: PROVIDER ENROLLMENT, MEMPHIS, TN 38103-2807
(901) 545-8336
(901) 545-8122
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
07/24/2014
Last updated
10/30/2017
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