Provider Demographics
NPI:1699913939
Name:RESURGE LLC
Entity type:Organization
Organization Name:RESURGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATAP
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP/A
Authorized Official - Phone:901-219-8505
Mailing Address - Street 1:10076 SUTTON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0685
Mailing Address - Country:US
Mailing Address - Phone:901-756-8871
Mailing Address - Fax:901-202-0336
Practice Address - Street 1:10076 SUTTON RIDGE LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0685
Practice Address - Country:US
Practice Address - Phone:901-756-8871
Practice Address - Fax:901-202-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1506231H00000X, 231HA2400X, 237600000X
TN1807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty