Provider Demographics
NPI:1952357931
Name:MID-SOUTH RESPICARE,INC.
Entity Type:Organization
Organization Name:MID-SOUTH RESPICARE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-473-5477
Mailing Address - Street 1:1100 SMITHVILLE HWY
Mailing Address - Street 2:SUITE 138
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1662
Mailing Address - Country:US
Mailing Address - Phone:931-473-5477
Mailing Address - Fax:931-473-6360
Practice Address - Street 1:1100 SMITHVILLE HWY
Practice Address - Street 2:SUITE 138
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1662
Practice Address - Country:US
Practice Address - Phone:931-473-5477
Practice Address - Fax:931-473-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000505332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952357931OtherTENNCARE
047731OtherBC/BS
66912OtherCARE CENTRIX
TN3548811Medicaid
1952357931OtherTENNCARE