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Contact Information

MID-SOUTH IMAGING & THERAPEUTICS, P.A.
7600 WOLF RIVER BLVD.
#200
GERMANTOWN, TN38138
 Phone: 901-747-1000
 Fax: 901-747-1001
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Diagnostic Radiology

2085R0202X 30 Physician/Diagnostic Radiology
 

Nurse Anesthetist, Certified Registered

367500000X 43 Certified Registered Nurse Anesthetist (CRNA)
 

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for MID-SOUTH IMAGING & THERAPEUTICS, P.A.

NPI # 1043260763
LBN Legal business name MID-SOUTH IMAGING & THERAPEUTICS, P.A.
Authorized official JOHN ELLZEY - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 05/11/2006
Last updated 10/16/2024 - More than a year ago
Identifiers
AR Medicaid 107365002
MO Medicaid 508212206
MS Medicaid 09013816
TN Medicaid 3373325
AR Other 86018 GROUP AR BCBS #
TN Other 0022687 GROUP TN BCBS #
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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