Basic Information
| Provider Information | |||||||||
| NPI: | 1255304143 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMHA | ||||||||
| FirstName: | SAMUEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1798 | ||||||||
| Address2: | DEPT 07-046 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381019715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012599200 | ||||||||
| FaxNumber: | 9013626618 | ||||||||
| Practice Location | |||||||||
| Address1: | 1028 CRESTHAVEN RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381193895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016808146 | ||||||||
| FaxNumber: | 9016808178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 02/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 23948 | TN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 3077122 | 05 | TN | MEDICAID |