Provider Demographics
NPI:1548211378
Name:INTERVENTIONAL CARDIOLOGY OF THE MIDSOUTH, INC.
Entity Type:Organization
Organization Name:INTERVENTIONAL CARDIOLOGY OF THE MIDSOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-725-0347
Mailing Address - Street 1:MSC 410705
Mailing Address - Street 2:PO BOX 415000
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37241-0001
Mailing Address - Country:US
Mailing Address - Phone:901-725-0347
Mailing Address - Fax:901-725-5359
Practice Address - Street 1:1211 UNION AVE
Practice Address - Street 2:SUITE 975
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6638
Practice Address - Country:US
Practice Address - Phone:901-725-0347
Practice Address - Fax:901-725-5359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000018928207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB00177Medicare UPIN