MEDICARE: MID SOUTH MED, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	MD0000006816	TN

General Provider Information

NPI Number	:	1356893226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID SOUTH MED, LLC

Provider Business Mailing Address
First Line	:	9160 HIGHWAY 64
Second Line	:	SUITE 5
City	:	LAKELAND
State	:	TN
Zip	:	38002-4766
Country	:	US
Telephone Number	:	901-623-3587
Fax Number	:	901-213-9235

Provider Business Practice Location Address
First Line	:	9160 HIGHWAY 64
Second Line	:	SUITE 5
City	:	LAKELAND
State	:	TN
Zip	:	38002-4766
Country	:	US
Telephone Number	:	901-623-3587
Fax Number	:	901-213-9235

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. OLIVER BANKS
Credential	:
Telephone Number	:	901-497-1040

Provider Enumeration Date	:	10/26/2016
Last Update Date	:	10/26/2016

Similar Medicare Providers

1649233206 — TOTAL RENAL CARE INC
Practice Location Address:

9160 HIGHWAY 64
LAKELAND, TN
38002-4766

Practice Phone: 901-380-1511
Practice Fax: 901-380-5624

1659481448 — MRS. RESA SATURDAY BARAWID P.T.
Practice Location Address:

9160 HIGHWAY 64 , SUITE 3
LAKELAND, TN
38002-4766

Practice Phone: 901-388-4474
Practice Fax: 901-388-4486

1386849859 — LYNN A. SAINO PT
Practice Location Address:

9160 HIGHWAY 64 , SUITE 3
LAKELAND, TN
38002-4766

Practice Phone: 901-388-4474
Practice Fax: 901-388-4486

1366917650 — DENNIS SMALL
Practice Location Address:

9160 HIGHWAY 64 STE 12-187
LAKELAND, TN
38002-4766

Practice Phone: 901-205-9032
Practice Fax: 901-292-9032

1720797988 — AMALIA JONES LCSW
Practice Location Address:

9160 US HIGHWAY 64 # 12-218
ARLINGTON, TN
38002-4766

Practice Phone: 901-245-3560
Practice Fax:

1134112766 — MARSHA V LEE M.D.
Practice Location Address:

8950 HWY 64 , SUITE 116
LAKELAND, TN
38002

Practice Phone: 901-383-7170
Practice Fax: 901-388-6478

Directions to “MID SOUTH MED, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.