Provider Demographics
NPI:1396737268
Name:INTERVENTIONAL ASSOCIATES OF MEMPHIS, PC
Entity type:Organization
Organization Name:INTERVENTIONAL ASSOCIATES OF MEMPHIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOODSIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-448-1644
Mailing Address - Street 1:66 N PAULINE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-5105
Mailing Address - Country:US
Mailing Address - Phone:901-448-2786
Mailing Address - Fax:901-448-1772
Practice Address - Street 1:66 N PAULINE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-5105
Practice Address - Country:US
Practice Address - Phone:901-448-2786
Practice Address - Fax:901-448-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3725782Medicare ID - Type UnspecifiedGROUP