Basic Information
| Provider Information | |||||||||
| NPI: | 1073592275 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-SOUTH PULMONARY SPECIALISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5050 POPLAR AVE | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381570101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012762662 | ||||||||
| FaxNumber: | 9012741871 | ||||||||
| Practice Location | |||||||||
| Address1: | 5050 POPLAR AVE | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381570101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012762662 | ||||||||
| FaxNumber: | 9012741871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2006 | ||||||||
| LastUpdateDate: | 11/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | AVERY | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | WEIS | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9013338443 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | JD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 2080S0012X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Sleep Medicine | 207RP1001X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.