1548211378 NPI number — INTERVENTIONAL CARDIOLOGY OF THE MIDSOUTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548211378 NPI number — INTERVENTIONAL CARDIOLOGY OF THE MIDSOUTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERVENTIONAL CARDIOLOGY OF THE MIDSOUTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548211378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MSC 410705
Provider Second Line Business Mailing Address:
PO BOX 415000
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37241-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-725-0347
Provider Business Mailing Address Fax Number:
901-725-5359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 UNION AVE
Provider Second Line Business Practice Location Address:
SUITE 975
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104-6638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-725-0347
Provider Business Practice Location Address Fax Number:
901-725-5359
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
901-725-0347

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  MD0000018928 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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