ENT Memphis – Specialist in Memphis, TN

Key facts

NPI: 1578848990
Entity type: Organization (NPI type 2)
Primary specialty: Specialist 174400000X
License: 016275 (TN)
Legal business name: ENT MEMPHIS
Practice address: 791 Estate PL
Memphis, TN 38120-0600
Phone: (901) 821-4300
Fax: (901) 821-4373
NPI assigned: Oct 17, 2011
Organization subpart: No

Authorized official

Name: Dr. Rande Harris Lazar, M.D.
Title: Owner
Phone: (901) 821-4317

National Provider Directory

Locations

791 Estate Pl
Memphis, TN 38120
Phone (901) 821-4300

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Specialist Group: 193400000X SINGLE SPECIALTY GROUP	174400000X	016275	TN	Yes

Addresses

Primary practice location

791 Estate PL
Memphis, TN 38120-0600

Mailing address

791 Estate PL
Memphis, TN 38120-0600
Phone (901) 821-4300

Other identifiers

Identifier	Type	State	Issuer
3014587	Medicaid	TN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 17, 2011.

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318809600000",
    "number": "1578848990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "791 ESTATE PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381200600",
            "telephone_number": "901-821-4300",
            "fax_number": "901-821-4373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "791 ESTATE PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381200600",
            "telephone_number": "901-821-4300",
            "fax_number": "901-821-4373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENT MEMPHIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-17",
        "last_updated": "2011-10-17",
        "status": "A",
        "authorized_official_last_name": "LAZAR",
        "authorized_official_first_name": "RANDE",
        "authorized_official_middle_name": "HARRIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-821-4317",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TN",
            "license": "016275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3014587",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

All providers in Memphis, TN · Specialist in Tennessee

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.