Provider Demographics
NPI:1467532754
Name:MID-SOUTH INTERNAL MEDICINE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:MID-SOUTH INTERNAL MEDICINE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-767-5000
Mailing Address - Street 1:7550 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1780
Mailing Address - Country:US
Mailing Address - Phone:901-767-5000
Mailing Address - Fax:901-767-6000
Practice Address - Street 1:7550 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1780
Practice Address - Country:US
Practice Address - Phone:901-767-5000
Practice Address - Fax:901-767-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CJ5009Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TN3702398Medicare ID - Type UnspecifiedGROUP ID