Healthcare Provider Details

I. General information

NPI: 1780017228
Provider Name (Legal Business Name): MID-SOUTH URGENT CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 N HOUSTON LEVEE RD SUITE 114
CORDOVA TN
38018-6687
US

IV. Provider business mailing address

PO BOX 5165
MEMPHIS TN
38101-5165
US

V. Phone/Fax

Practice location:
  • Phone: 901-421-5000
  • Fax: 901-572-1241
Mailing address:
  • Phone: 901-421-5000
  • Fax: 901-572-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MOHAMMED BAH
Title or Position: PRESIDENT
Credential: MD
Phone: 901-421-5000