Provider Demographics
NPI:1104922392
Name:WOMENS DIAGNOSTIC GROUP PLLC
Entity type:Organization
Organization Name:WOMENS DIAGNOSTIC GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-226-0811
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 34 WOMENS DIAGNOSTIC GROUP PLLC
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-383-1194
Mailing Address - Fax:
Practice Address - Street 1:50 HUMPHREYS CENTER
Practice Address - Street 2:SUITE 23
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2373
Practice Address - Country:US
Practice Address - Phone:901-383-1194
Practice Address - Fax:901-383-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04483898Medicaid
MS05675086Medicaid
TN4053282OtherBCBS
TN3377147Medicaid
MS07421890Medicaid
AR8P034OtherBCBS
TN3377147Medicare ID - Type Unspecified