Organization
PAS OF MEMPHIS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRA ANDRE RICHARDSON CRNA (OWNER)
(662) 349-2588
Entity
Organization
Contact information
Practice address
7900 AIRWAYS BLVD, BUILDING C, SUITE 2, SOUTHAVEN, MS 38671-4113
(662) 349-5554
Mailing address
PO BOX 235022, MONTGOMERY, AL 36123-5022
(334) 386-2053
(334) 244-1830
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09852342
—
MS
Enumeration date
02/28/2008
Last updated
02/28/2008
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