Provider Demographics
NPI:1164734232
Name:MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC
Entity Type:Organization
Organization Name:MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
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:901-531-8549
Mailing Address - Fax:901-271-9099
Practice Address - Street 1:1365 W BRIERBROOK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2208
Practice Address - Country:US
Practice Address - Phone:901-531-8549
Practice Address - Fax:901-271-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN212OtherPAIN CLINIC REGISTRATION--TN DEPT OF HEALTH
TN1522535Medicaid
TN212OtherPAIN CLINIC REGISTRATION--TN DEPT OF HEALTH