Organization
OTOLARYNGOLOGY CONSULTANTS OF MEMPHIS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA MALADY (BILLING)
(901) 737-3071
Entity
Organization
Contact information
Practice address
791 ESTATE PL, MEMPHIS, TN 38120-0600
(901) 821-4300
Mailing address
791 ESTATE PL, MEMPHIS, TN 38120-0600
(901) 821-4300
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD016275
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0063113
BCBS ID NUMBER
TN
01
—
3014587
MEDICAID HMOS
TN
05
—
3014587
—
TN
Enumeration date
03/21/2007
Last updated
08/22/2020
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