Delta Convenient Care PC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

DELTA CONVENIENT CARE PC

Doing business as

Heart & Vascular Center of West Tennessee

Practice address

17 Centre Plaza Dr
Jackson, TN 38305-2862

Phone

(731) 512-0104

Fax

(731) 512-0938

NPI assigned

Jun 3, 2006

Organization subpart

No

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

Authorized official

Name

Elie Hage-Korban, M.D.

Title

Authorized Official

Phone

(731) 512-0104

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Heart & Vascular Center of West Tennessee Doing business as

Locations

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401926400000",
    "number": "1629016399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 CENTRE PLAZA DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052862",
            "telephone_number": "731-512-0104",
            "fax_number": "731-512-0938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 CENTRE PLAZA DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052862",
            "telephone_number": "731-512-0104",
            "fax_number": "731-512-0938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA CONVENIENT CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2014-06-05",
        "status": "A",
        "authorized_official_last_name": "HAGE-KORBAN",
        "authorized_official_first_name": "ELIE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "731-512-0104",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3720558",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heart & Vascular Center of West Tennessee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria Sandra Dee, M.D.
• Alan C Dejarnatt, MD
• Kara A. Delk, P.T.A.
• Jennifer Dawn Delong, BS
• Delta Clinics, P.L.C.
• Kaylee Ann Demar, SLP
• Melissa B Dennison, PHARMACIST
• Dental Associates Inc
• Karen E Depriest, PHARM D
• Dermatology Associates LLC

• Cardiovascular Disease Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Cardiovascular Disease Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; 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.