Provider Demographics
NPI:1669725297
Name:FAMILY EAR NOSE & THROAT CARE OF THE MID-SOUTH, PLLC
Entity type:Organization
Organization Name:FAMILY EAR NOSE & THROAT CARE OF THE MID-SOUTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-363-8400
Mailing Address - Street 1:6616 KIRBY CENTER CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4313
Mailing Address - Country:US
Mailing Address - Phone:901-363-8400
Mailing Address - Fax:901-363-8644
Practice Address - Street 1:6616 KIRBY CENTER CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4313
Practice Address - Country:US
Practice Address - Phone:901-363-8400
Practice Address - Fax:901-363-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty