Provider Demographics
NPI:1164965406
Name:GASTROENTEROLOGY CENTER OF THE MIDSOUTH PC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CENTER OF THE MIDSOUTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANCILLARY SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-747-3630
Mailing Address - Street 1:1419 KENSINGTON SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-6939
Mailing Address - Country:US
Mailing Address - Phone:615-396-9080
Mailing Address - Fax:855-744-6439
Practice Address - Street 1:3350 N GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4026
Practice Address - Country:US
Practice Address - Phone:901-747-3630
Practice Address - Fax:855-744-6439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site