Provider Demographics
NPI:1386844504
Name:MID-SOUTH TRANSPLANT FOUNDATION, INC.
Entity Type:Organization
Organization Name:MID-SOUTH TRANSPLANT FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-328-4438
Mailing Address - Street 1:8001 CENTERVIEW PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4228
Mailing Address - Country:US
Mailing Address - Phone:901-328-4438
Mailing Address - Fax:901-328-4462
Practice Address - Street 1:8001 CENTERVIEW PKWY STE 302
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4228
Practice Address - Country:US
Practice Address - Phone:901-328-4438
Practice Address - Fax:901-328-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002214291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44HL02Medicare Oscar/Certification