| Dr Jonathan J Ellichman, MD | |
|
6401 Poplar Ave Ste 410, Memphis, TN 38119-4808 | |
| (901) 259-2718 | |
| (901) 259-1123 |
| Full Name | Dr Jonathan J Ellichman |
|---|---|
| Gender | Male |
| Speciality | Cardiac Surgery |
| Experience | 26 Years |
| Location | 6401 Poplar Ave Ste 410, Memphis, Tennessee |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073538823 | NPI | - | NPPES |
| 30005342 | Medicaid | TN | |
| 165449001 | Medicaid | AR | |
| 06336753 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2086S0129X | Surgery - Vascular Surgery | 18972 (Mississippi) | Primary |
| 208G00000X | Thoracic Surgery (cardiothoracic Vascular Surgery) | 39618 (Tennessee) | Secondary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Southern Cardiovascular Pllc | 0042388373 | 3 |
| Entity Name | Southern Cardiovascular Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1447415104 PECOS PAC ID: 0042388373 Enrollment ID: O20130605000019 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Jonathan J Ellichman, MD 1779 Kirby Pkwy # 1-511, Memphis, TN 38138-3666 Ph: (901) 371-5218 | Dr Jonathan J Ellichman, MD 6401 Poplar Ave Ste 410, Memphis, TN 38119-4808 Ph: (901) 259-2718 |
Leonard Harvey Hines, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 6005 Park Ave, Suite 821-b, Memphis, TN 38119 Phone: 901-726-1056 Fax: 901-726-5867 | |
Dr. Robert D Wallace, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1068 Cresthaven Rd Ste 500, Memphis, TN 38119 Phone: 901-866-8525 | |
Dr. Dan Huff Shell Iii, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1068 Cresthaven Rd Ste 200, Memphis, TN 38119 Phone: 901-761-4844 Fax: 901-761-6929 | |
Randall William Franz, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1325 Eastmoreland Ave Ste 365, Memphis, TN 38104 Phone: 901-272-6018 Fax: 901-201-4203 | |
Dr. Christine T Mroz, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 6005 Park, #700, Memphis, TN 38119 Phone: 901-527-3391 Fax: 901-578-3969 | |
Miriam Wing San Tsao, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 1211 Union Ave Suite 300, Memphis, TN 38104 Phone: 901-516-0792 Fax: 901-266-6415 |