Provider Demographics
NPI:1184624454
Name:MID-SOUTH CANCER CENTER
Entity type:Organization
Organization Name:MID-SOUTH CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-763-0446
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DPT 242
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0242
Mailing Address - Country:US
Mailing Address - Phone:901-763-0446
Mailing Address - Fax:901-763-0042
Practice Address - Street 1:8000 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1727
Practice Address - Country:US
Practice Address - Phone:901-763-0446
Practice Address - Fax:901-763-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08051843Medicaid
AR5F008OtherBC OF AR
MS06508079Medicaid
TN149557Medicaid
TN4078501OtherBCBS
MS08051843Medicaid
AR5F008OtherBC OF AR
TNDB2406Medicare ID - Type UnspecifiedRAILROAD
TN149557Medicaid
MS06508079Medicaid