Provider Demographics
NPI:1912303447
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:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSCITTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-641-3000
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:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:
Practice Address - Street 1:7580 CLARINGTON CV
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:901-641-3000
Practice Address - Fax:901-259-1698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MSK GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-11
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22398207X00000X, 207X00000X
MS17655207X00000X
MS21167207X00000X
MS22592207X00000X
MS22593207X00000X
MS22446207X00000X
MS12381207X00000X
MS22338207XS0106X
MS18745207XS0106X
MS5444225100000X
MS5445225100000X
MS5428225100000X
MSA810556363LF0000X
MS20548207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCA9441OtherRAILROAD MEDICARE
MS388348OtherMEDICARE PTAN PART B
MS388348OtherMEDICARE PTAN PART B
MS7187860Medicaid
TN3371161Medicaid
MS7187860Medicaid
MS7187860Medicaid