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General NPI Number Information
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NPI Number | 1063938520
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Entity Type | Organization
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Legal Business Name | MID-SOUTH CONVENIENT CARE, PLLC
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 1445 US HIGHWAY 51 BYP E STE B
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City | DYERSBURG
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State | TN
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Zip | 38024-2127
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Country | US
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Telephone | 731-286-1900
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Fax | 731-286-1900
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Provider Business Mailing Address
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Address Line | 1445 US HIGHWAY 51 BYP E STE B
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City | DYERSBURG
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State | TN
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Zip | 38024-2127
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Country | US
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Telephone | 731-286-1900
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Fax | 731-286-1939
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Authorized Official
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Title or Position | ADMIN
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Name | PATRICIA FAYE OWEN
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Credential |
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Telephone | 731-286-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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