Provider Demographics
NPI:1003829664
Name:MID SOUTH ORTHOPEDIC ASSOCIATES PC
Entity Type:Organization
Organization Name:MID SOUTH ORTHOPEDIC ASSOCIATES PC
Other - Org Name:SCHRADER ORTHOPEDICS AND STEM CELL TREATMENT CENTER, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-465-4300
Mailing Address - Street 1:927 CORDOVA STATION AVE
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6316
Mailing Address - Country:US
Mailing Address - Phone:901-465-4300
Mailing Address - Fax:901-465-3357
Practice Address - Street 1:927 CORDOVA STATION AVE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6316
Practice Address - Country:US
Practice Address - Phone:901-465-4300
Practice Address - Fax:901-465-3357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28886207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000028886Medicaid
E28504Medicare UPIN
TN0000028886Medicaid