Provider Demographics
NPI:1073592275
Name:MID-SOUTH PULMONARY SPECIALISTS PC
Entity Type:Organization
Organization Name:MID-SOUTH PULMONARY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:WEIS
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:901-333-8443
Mailing Address - Street 1:5050 POPLAR AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38157-0101
Mailing Address - Country:US
Mailing Address - Phone:901-276-2662
Mailing Address - Fax:901-274-1871
Practice Address - Street 1:5050 POPLAR AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38157-0101
Practice Address - Country:US
Practice Address - Phone:901-276-2662
Practice Address - Fax:901-274-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702792Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
TN3702793Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER