Provider Demographics
NPI:1083898605
Name:MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC
Entity Type:Organization
Organization Name:MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC
Other - Org Name:MIDSOUTH PAIN TREATMENT CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:STEUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-624-6517
Mailing Address - Street 1:1365 W BRIERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2208
Mailing Address - Country:US
Mailing Address - Phone:901-624-6517
Mailing Address - Fax:901-624-6521
Practice Address - Street 1:122 AIRWAYS PL
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5872
Practice Address - Country:US
Practice Address - Phone:662-349-9990
Practice Address - Fax:662-349-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1703261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25C0001051Medicare Oscar/Certification
MS512G490001Medicare PIN