Provider Demographics
NPI:1942497854
Name:MID-SOUTH PODIATRY, LLC
Entity Type:Organization
Organization Name:MID-SOUTH PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:931-629-7176
Mailing Address - Street 1:3203 CARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-8645
Mailing Address - Country:US
Mailing Address - Phone:931-629-7176
Mailing Address - Fax:931-223-5459
Practice Address - Street 1:1950 PICKWICK ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-5309
Practice Address - Country:US
Practice Address - Phone:931-629-7176
Practice Address - Fax:931-223-5459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370132Medicaid
TN3370132Medicaid
TN6193430001Medicare NSC
MS512G700123Medicare PIN