Mid South Vascular Clinic

LBN: Mid South Vascular Clinic
Mid South Vascular Clinic is an health care organization with primary practice located at 6027 Walnut Grove Rd Suite 205, Memphis TN 38120-2145. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as the primary health care specialty. Mid South Vascular Clinic can be contacted via phone (901) 683-4471, or through Davis, Jesse T via phone (901) 683-4471.

Contact Information

Primary practice address
6027 Walnut Grove Rd Suite 205 Memphis TN 38120-2145
Phone: (901) 683-4471
Fax: (901) 683-3915
Website:
Map and Directions
Authorized official contact:
Name: Davis, Jesse T Doctor of Medicine (MD)
Phone: (901) 683-4471

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 06816 Tennessee

Profile Details

NPI number 1003837279
LBN Legal business name Mid South Vascular Clinic
DBA Doing business as
Authorized official Davis, Jesse T Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jul 22nd, 2006
Last updated Jul 8th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003837279 NPPES
Tennessee MEDICAID 3149502

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