POPLAR AVENUE CLINIC PLLC NPI 1124588793

NPI Information

NPI: 1124588793
Provider Name: POPLAR AVENUE CLINIC PLLC

Doing Business As: POPLAR AVENUE CLINIC PLLC

Classification: Obstetrics & Gynecology - 207VX0201X
Entity Type: Organization

Specialization: Gynecologic Oncology

Address:
6584 POPLAR AVE STE 400
MEMPHIS, TN
ZIP 38138
Phone: (901) 300-6713
Get Directions

POPLAR AVENUE CLINIC PLLC is a gynecologic oncology obstetrics gynecology in Memphis, TN. The provider is an obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications. POPLAR AVENUE CLINIC PLLC NPI is 1124588793. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Poplar Avenue Clinic Pllc.

The provider's business location address is:

6584 POPLAR AVE STE 400
MEMPHIS, TN
ZIP 38138-687
Phone: (901) 300-6713
Fax: (901) 552-5891

The provider's authorized official is Huda Alaeddin .
The authorized official title is Office Manager and has the following contact phone number (901) 870-8840.

The CLIA number assigned to this NPI record is 44D2166617 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 3/20/2019 and was last updated on 9/6/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	2085R0204X	Radiology	Vascular & Interventional Radiology	No
2	2086S0129X	Surgery	Vascular Surgery	No
3	261QF0050X	Clinic/Center	Family Planning, Non-Surgical	No
4	261QM1300X	Clinic/Center	Multi-Specialty	No
5	261QM2500X	Clinic/Center	Medical Specialty	No
6	261QP2300X	Clinic/Center	Primary Care	No
7	261QU0200X	Clinic/Center	Urgent Care	No
8	363A00000X	Physician Assistant		No
9	363AM0700X	Physician Assistant	Medical	No
10	363AS0400X	Physician Assistant	Surgical	No
11	363LW0102X	Nurse Practitioner	Women's Health	No
12	367500000X	Nurse Anesthetist, Certified Registered		No
13	207VX0201X	Obstetrics & Gynecology	Gynecologic Oncology	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	893541	MEDICAID	TENNESSEE
2	6528091	MEDICAID	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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