Provider Demographics
NPI:1518920404
Name:MID-SOUTH NEUROSURGERY, INC.
Entity Type:Organization
Organization Name:MID-SOUTH NEUROSURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:MATT
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-7024
Mailing Address - Street 1:P.O. BOX 6004
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403
Mailing Address - Country:US
Mailing Address - Phone:870-932-3850
Mailing Address - Fax:870-932-5699
Practice Address - Street 1:800 S. CHURCH
Practice Address - Street 2:SUITE 203
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-932-3850
Practice Address - Fax:870-932-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARDC9398OtherRAILROAD
AR5F139Medicare ID - Type Unspecified