Healthcare Provider Details

I. General information

NPI: 1073421392
Provider Name (Legal Business Name): MID-SOUTH HEMOPHILIA AND THROMBOSIS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2996 KATE BOND RD STE 105
BARTLETT TN
38133-4062
US

IV. Provider business mailing address

8326 NAAB RD
INDIANAPOLIS IN
46260-1920
US

V. Phone/Fax

Practice location:
  • Phone: 317-871-0000
  • Fax:
Mailing address:
  • Phone: 317-871-0000
  • Fax: 317-871-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC D GRAY
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 317-871-0000