Provider Demographics
NPI:1033295886
Name:MSK GROUP, PC
Entity Type:Organization
Organization Name:MSK GROUP, PC
Other - Org Name:ORTHOSOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSCITTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-641-3000
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:
Practice Address - Street 1:1350 CONCOURSE AVE STE 363
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2023
Practice Address - Country:US
Practice Address - Phone:901-260-6161
Practice Address - Fax:901-260-6162
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MSK GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207X00000X, 208100000X, 332B00000X
208VP0014X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0970OtherLICENSE PAIN MANAGEMENT CLINIC