Provider Demographics
NPI:1326741844
Name:MID-SOUTH URGENT CARE, PLLC
Entity Type:Organization
Organization Name:MID-SOUTH URGENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-212-2579
Mailing Address - Street 1:PO BOX 5165
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-5165
Mailing Address - Country:US
Mailing Address - Phone:901-779-8657
Mailing Address - Fax:901-791-4208
Practice Address - Street 1:5905 STAGE RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4521
Practice Address - Country:US
Practice Address - Phone:901-779-8657
Practice Address - Fax:901-791-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty