Provider Demographics
NPI: | 1114186574 |
---|---|
Name: | THE STERN CARDIOVASCULAR CENTER |
Entity type: | Organization |
Organization Name: | THE STERN CARDIOVASCULAR CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF OPERATING OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DEBBIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | EDDLESTONE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 901-271-2272 |
Mailing Address - Street 1: | 7362 SOUTHCREST PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | SOUTHAVEN |
Mailing Address - State: | MS |
Mailing Address - Zip Code: | 38671-4773 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 901-271-1000 |
Mailing Address - Fax: | 901-271-2161 |
Practice Address - Street 1: | 7362 SOUTHCREST PKWY |
Practice Address - Street 2: | |
Practice Address - City: | SOUTHAVEN |
Practice Address - State: | MS |
Practice Address - Zip Code: | 38671-4773 |
Practice Address - Country: | US |
Practice Address - Phone: | 901-271-1000 |
Practice Address - Fax: | 901-271-2161 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-06-02 |
Last Update Date: | 2008-06-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Single Specialty |