Provider Demographics
NPI:1699076414
Name:LIFELINC INTERVENTIONAL PLLC
Entity type:Organization
Organization Name:LIFELINC INTERVENTIONAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-844-1590
Mailing Address - Street 1:1331 UNION AVE STE 927
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7555
Mailing Address - Country:US
Mailing Address - Phone:901-844-1590
Mailing Address - Fax:901-844-1592
Practice Address - Street 1:1331 UNION AVE STE 927
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7555
Practice Address - Country:US
Practice Address - Phone:901-844-1590
Practice Address - Fax:901-844-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty