Healthcare Provider Details

I. General information

NPI: 1073360061
Provider Name (Legal Business Name): MID-SOUTH VASCULAR PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6584 POPLAR AVE STE 102
MEMPHIS TN
38138-0620
US

IV. Provider business mailing address

6584 POPLAR AVE STE 102
MEMPHIS TN
38138-0620
US

V. Phone/Fax

Practice location:
  • Phone: 901-519-4690
  • Fax: 901-519-4691
Mailing address:
  • Phone: 901-519-4690
  • Fax: 901-519-4691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SALIL SUDHIR JOSHI
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 901-519-4690