Provider Demographics
NPI:1578677761
Name:MID-SOUTH CARDIOLOGY
Entity Type:Organization
Organization Name:MID-SOUTH CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DISMUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-444-2320
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-5000
Mailing Address - Country:US
Mailing Address - Phone:615-444-2320
Mailing Address - Fax:615-449-3163
Practice Address - Street 1:1423 W. BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-449-6868
Practice Address - Fax:615-449-3163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710401Medicare ID - Type UnspecifiedMEDICARE, PART B, CIGNA