Provider Demographics
NPI:1336816388
Name:METROPOLITAN CARDIOVASCULAR INSTITUTE
Entity type:Organization
Organization Name:METROPOLITAN CARDIOVASCULAR INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DISHMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-596-4096
Mailing Address - Street 1:2386 CARTERS GROVE LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-4904
Mailing Address - Country:US
Mailing Address - Phone:901-596-4096
Mailing Address - Fax:
Practice Address - Street 1:1975 NONCONNAH BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2108
Practice Address - Country:US
Practice Address - Phone:901-337-1625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty