| Paul R Tanner, MD | |
|
6019 Walnut Grove, Memphis, TN 38120 | |
| (901) 383-8860 | |
| (901) 383-1194 |
| Full Name | Paul R Tanner |
|---|---|
| Gender | Male |
| Speciality | Diagnostic Radiology |
| Experience | 34 Years |
| Location | 6019 Walnut Grove, 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 |
|---|---|---|---|
| 1003921404 | NPI | - | NPPES |
| 3016599 | Other | TN | BCBS |
| P00074329 | Other | MS | MEDICARE RR |
| 00115692 | Medicaid | MS | |
| 3092642 | Medicaid | TN | |
| 97090 | Other | AR | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 25372 (Tennessee) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Baptist Memorial Hospital | Memphis, TN | Hospital |
| Baptist Memorial Hospital Desoto | Southaven, MS | Hospital |
| Baptist Memorial Hospital Jonesboro, Inc. | Jonesboro, AR | Hospital |
| Baptist Memorial Hospital Tipton | Covington, TN | Hospital |
| Baptist Memorial Hospital Union City | Union city, TN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| West Tennessee Imaging Llc | 3173834215 | 37 |
| Baptist Memorial Medical Group, Inc. | 5193610228 | 468 |
| Mid-south Imaging And Therapeutics, P.a. | 9133106396 | 76 |
| Mid-south Imaging And Therapeutics, P.a. | 9133106396 | 76 |
| Northeast Arkansas Clinic Charitable Foundation, Inc. | 2961547526 | 272 |
| Mid-south Imaging And Therapeutics, P.a. | 9133106396 | 76 |
| Entity Name | Baptist Memorial Medical Group, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1306089206 PECOS PAC ID: 5193610228 Enrollment ID: O20040218000385 |
| Entity Name | Mid-south Imaging & Therapeutics, P.a. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1043260763 PECOS PAC ID: 9133106396 Enrollment ID: O20040706000767 |
| Entity Name | West Tennessee Imaging Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912395708 PECOS PAC ID: 3173834215 Enrollment ID: O20150616002796 |
| Mailing Address | Practice Location Address |
|---|---|
| Paul R Tanner, MD Po Box 2121, Memphis, TN 38159 Ph: (901) 383-8860 | Paul R Tanner, MD 6019 Walnut Grove, Memphis, TN 38120 Ph: (901) 383-8860 |
Dr. Daniel Wakefield, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 920 Madison Ave, Suite 447, Memphis, TN 38103 Phone: 901-448-5814 | |
Madison H Buckley Jr., MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 50 Humphreys Ctr, Suite 23, Memphis, TN 38120 Phone: 901-226-0810 Fax: 901-383-8985 | |
Martha E Glenn, MD Radiology Medicare: Medicare Enrolled Practice Location: 6215 Humphreys Blvd, Suite 100, Memphis, TN 38120 Phone: 901-227-9650 | |
Matthew T. Ballo, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 100 N Humphreys Blvd, Memphis, TN 38120 Phone: 901-683-0055 Fax: 901-685-2969 | |
Terry L Thompson, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 5959 Park Ave, Radiology Department, Memphis, TN 38119 Phone: 901-765-3212 Fax: 901-765-3212 | |
Stefan J Cowles, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 5959 Park Ave, Radiology Department, Memphis, TN 38119 Phone: 901-765-3212 Fax: 901-765-1727 |