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MID-SOUTH RECTAL CLINIC INC. NPI 1316024193


NPI Information

NPI: 1316024193
Provider Name: MID-SOUTH RECTAL CLINIC, INC.
Classification: Surgery - 208600000X
Entity Type: Organization

CLIA Number: 44D0686235

Address:
6563 STAGE OAKS DR
SUITE 100
BARTLETT, TN
ZIP 38134
Phone: (901) 362-5252
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MID-SOUTH RECTAL CLINIC, INC. is a surgery in Bartlett, TN. The provider is a general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. MID-SOUTH RECTAL CLINIC, INC. NPI is 1316024193. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6563 STAGE OAKS DR
SUITE 100
BARTLETT, TN
ZIP 38134-886
Phone: (901) 362-5252
Fax: (901) 369-4775

The provider's authorized official is Michael M. Fox .
The authorized official title is Provider/owner and has the following contact phone number (901) 362-5252.

The CLIA number assigned to this NPI record is 44D0686235 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 11/1/2006 and was last updated on 2/1/2016.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208600000XSurgery36972TENNESSEEYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1B97856MEDICARE UPINTENNESSEE
23727193MEDICAIDTENNESSEE
3C03583MEDICARE PINMISSISSIPPI
4155546001MEDICAIDALASKA
501702559MEDICAIDMISSISSIPPI
63727193MEDICARE 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: 5/5/2024

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