Provider Demographics
NPI:1598892325
Name:MEMPHIS MIDSOUTH OBGYN ALLIANCE P.C.
Entity Type:Organization
Organization Name:MEMPHIS MIDSOUTH OBGYN ALLIANCE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-685-7342
Mailing Address - Street 1:6215 HUMPREHYS BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-685-7342
Mailing Address - Fax:901-767-0423
Practice Address - Street 1:6215 HUMPREHYS BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-685-7342
Practice Address - Fax:901-767-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3387148Medicare ID - Type UnspecifiedMEDICARE