Provider Demographics
NPI:1811999394
Name:GASTROENTEROLOGY CENTER OF THE MIDSOUTH
Entity type:Organization
Organization Name:GASTROENTEROLOGY CENTER OF THE MIDSOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:CATHLEEN
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-737-4665
Mailing Address - Street 1:65 GERMANTOWN CT STE 300
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4258
Mailing Address - Country:US
Mailing Address - Phone:901-737-4665
Mailing Address - Fax:901-747-4039
Practice Address - Street 1:8000 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1727
Practice Address - Country:US
Practice Address - Phone:901-747-3630
Practice Address - Fax:901-747-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-14
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty