Provider Demographics
NPI:1679717656
Name:MID-SOUTH LUNG CENTER PLC
Entity Type:Organization
Organization Name:MID-SOUTH LUNG CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-423-8383
Mailing Address - Street 1:48 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3947
Mailing Address - Country:US
Mailing Address - Phone:731-423-8383
Mailing Address - Fax:731-424-6309
Practice Address - Street 1:48 MEDICAL CENTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3947
Practice Address - Country:US
Practice Address - Phone:731-423-8383
Practice Address - Fax:731-424-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000044770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty