MIDSOUTH INTEGRATIVE MEDICAL INC NPI 1568089993

NPI Information

NPI: 1568089993
Provider Name: MIDSOUTH INTEGRATIVE MEDICAL, INC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 25D1040419

Address:
7651 TCHULAHOMA RD
SOUTHAVEN, MS
ZIP 38671
Phone: (662) 349-0980
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MIDSOUTH INTEGRATIVE MEDICAL, INC is a primary care clinic center in Southaven, MS. MIDSOUTH INTEGRATIVE MEDICAL, INC NPI is 1568089993. The provider is registered as an organization entity type.

The provider's business location address is:

7651 TCHULAHOMA RD
SOUTHAVEN, MS
ZIP 38671-227
Phone: (662) 349-0980
Fax: (662) 349-0980

The provider's authorized official is Meagan Chastant-qualls .
The authorized official title is Nurse Practitioner and has the following contact phone number (662) 349-0980.

The CLIA number assigned to this NPI record is 25D1040419 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/1/2020 and was last updated on 7/1/2020.

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
1	261QP2300X	Clinic/Center	Primary Care			Yes

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: 11/14/2023

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