Provider Demographics
NPI:1336862952
Name:MSK GROUP, PC
Entity Type:Organization
Organization Name:MSK GROUP, PC
Other - Org Name:ORTHOSOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-725-8347
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5754
Mailing Address - Country:US
Mailing Address - Phone:901-259-1673
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:13690 HIGHWAY 51 S STE 104
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-7645
Practice Address - Country:US
Practice Address - Phone:901-641-3000
Practice Address - Fax:901-373-0804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MSK GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-20
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3371161OtherMEDICARE PART B