Centrosalud PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD000035089 Issued in TN

Legal business name

CENTROSALUD PC

Practice address

1068 Cresthaven Rd
Suite 300
Memphis, TN 38119-0800

Phone

(901) 683-0024

Fax

(901) 683-0028

NPI assigned

Feb 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dwight B Cowan

Title

Coo

Phone

(901) 531-8800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• LifeDOC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282003200000",
    "number": "1003951963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6063 MOUNT MORIAH ROAD EXT",
            "address_2": "SUITE 4",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381152644",
            "telephone_number": "901-531-8800",
            "fax_number": "901-531-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD",
            "address_2": "SUITE 300",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190800",
            "telephone_number": "901-683-0024",
            "fax_number": "901-683-0028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTROSALUD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2010-08-17",
        "status": "A",
        "authorized_official_last_name": "COWAN",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "901-531-8800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TN",
            "license": "MD000035089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "3728771",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeDOC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Memphis, TN
• Providers in Memphis, TN by specialty
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.