Provider Demographics
| NPI: | 1376541409 |
|---|---|
| Name: | MSK GROUP, PC |
| Entity Type: | Organization |
| Organization Name: | MSK GROUP, PC |
| Other - Org Name: | ORTHOSOUTH |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | C.E.O. |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | KIM |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | JENKINS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 901-641-3000 |
| Mailing Address - Street 1: | 6077 PRIMACY PKWY STE 140 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MEMPHIS |
| Mailing Address - State: | TN |
| Mailing Address - Zip Code: | 38119-5742 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 901-725-8347 |
| Mailing Address - Fax: | 901-259-1673 |
| Practice Address - Street 1: | 6286 BRIARCREST AVE STE 110&200 |
| Practice Address - Street 2: | |
| Practice Address - City: | MEMPHIS |
| Practice Address - State: | TN |
| Practice Address - Zip Code: | 38120-4023 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 901-259-1600 |
| Practice Address - Fax: | 901-259-1698 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-07-12 |
| Last Update Date: | 2022-08-30 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
| No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Multi-Specialty |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AR | 110318002 | Medicaid | |
| TN | CA9441 | Other | RAILROAD MEDICARE |
| TN | 2006894 | Other | BCBS TN |
| TN | 3371161 | Medicaid | |
| MS | 7187860 | Medicaid | |
| TN | ========= | Other | CIGNA |
| TN | 3371161 | Medicaid | |
| TN | ========= | Other | CIGNA |
| MS | 7187860 | Medicaid | |
| AR | 0723280013 | Medicare NSC | |
| MS | 0723280012 | Medicare NSC |
