Provider Demographics
NPI:1689439481
Name:MID-SOUTH MEDICAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:MID-SOUTH MEDICAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN-HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-210-0606
Mailing Address - Street 1:8105 RASOR BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-0336
Mailing Address - Country:US
Mailing Address - Phone:214-210-0606
Mailing Address - Fax:855-844-1068
Practice Address - Street 1:8105 RASOR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-0336
Practice Address - Country:US
Practice Address - Phone:214-210-0606
Practice Address - Fax:855-844-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty