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MID-SOUTH RENAL CLINIC PLC NPI 1093724346


NPI Information

NPI: 1093724346
Provider Name: MID-SOUTH RENAL CLINIC, PLC
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 04D0978617

Address:
1120 STATE HIGHWAY 77 STE 1
MARION, AR
ZIP 72364
Phone: (870) 733-1177
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MID-SOUTH RENAL CLINIC, PLC is a specialist in Marion, AR. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. MID-SOUTH RENAL CLINIC, PLC NPI is 1093724346. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1120 STATE HIGHWAY 77 STE 1
MARION, AR
ZIP 72364-046
Phone: (870) 733-1177
Fax: (870) 702-6128

The provider's authorized official is Mashhud M. Mirza .
The authorized official title is President and has the following contact phone number (870) 733-1177.

The CLIA number assigned to this NPI record is 04D0978617 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/5/2006 and was last updated on 5/3/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1110217316OTHERRAILROAD MEDICARE
2159373002MEDICAIDARKANSAS
35F061MEDICARE PINARKANSAS
43154566OTHERTENNESSEEBLUE CROSS BLUE SHIELD
55K483OTHERARKANSASBLUE CROSS BLUE SHIELD
63723240MEDICARE PINTENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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