Modern Vascular of Memphis LLC

Primary specialty

Vascular-Interventional Technology Radiologic TechnologistTaxonomy code 2471V0106X

Legal business name

MODERN VASCULAR OF MEMPHIS LLC

Practice address

5645 Murray Ave
Memphis, TN 38119-3831

Phone

(901) 633-1190

Fax

(901) 881-7979

NPI assigned

Jan 20, 2021

Organization subpart

No

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

Authorized official

Name

Yury Gampel

Title

Manager

Phone

(818) 262-6423

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1811587132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26500 AGOURA RD STE 102-587",
            "city": "CALABASAS",
            "state": "CA",
            "postal_code": "913021952",
            "telephone_number": "818-880-8605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 MURRAY AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381193831",
            "telephone_number": "901-633-1190",
            "fax_number": "901-881-7979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN VASCULAR OF MEMPHIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-20",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "GAMPEL",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "818-262-6423"
    },
    "taxonomies": [
        {
            "code": "2471C1101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Cardiovascular-Interventional Technology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471V0106X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Vascular-Interventional Technology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Lindsey Mobley, MD
• Joshua Mock, PTA
• Mariana Moctezuma Davila, MD
• Modern Gynecology and Reproductive Health PC
• Modern Health, LLC
• Anice Robinson Modesto, PH.D.
• Vanraj M Modhvadia, DDS
• William Lee Moffatt III, MD
• Jared Moffett, DMD
• Sagal Yusuf Mohamed, MD

• Radiologic Technologist in Memphis, TN
• Providers in Memphis, TN by specialty
• Radiologic Technologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; 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.