Provider Demographics
NPI:1689769234
Name:MID-TOWN INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:MID-TOWN INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-454-5117
Mailing Address - Street 1:48 S. PRESCOTT
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111
Mailing Address - Country:US
Mailing Address - Phone:901-454-5117
Mailing Address - Fax:901-454-1799
Practice Address - Street 1:48 S. PRESCOTT
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111
Practice Address - Country:US
Practice Address - Phone:901-454-5117
Practice Address - Fax:901-454-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370300Medicare ID - Type Unspecified