| Perisco Wofford Md Pllc | |
|
4567 Millbranch Rd Memphis TN 38116-7437 | |
| (901) 345-1454 | |
| (901) 345-1456 |
| Full Name | Perisco Wofford Md Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4567 Millbranch Rd, Memphis, Tennessee |
| Authorized Official Name and Position | Perisco Wofford (OWNER) |
| Authorized Official Contact | 9013451454 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Perisco Wofford Md Pllc 4567 Millbranch Rd Memphis TN 38116-7437 Ph: (901) 345-1454 | Perisco Wofford Md Pllc 4567 Millbranch Rd Memphis TN 38116-7437 Ph: (901) 345-1454 |
| NPI Number | 1447678776 |
|---|---|
| Provider Enumeration Date | 04/03/2014 |
| Last Update Date | 04/03/2014 |
| Medicare PECOS PAC ID | 7416171921 |
|---|---|
| Medicare Enrollment ID | O20140623002471 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447678776 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | MD0000037436 (Tennessee) | Primary |
| Provider Name | Perisco A Wofford |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1922000918 PECOS PAC ID: 1951374164 Enrollment ID: I20081009000227 |
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