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General NPI Number Information
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NPI Number | 1093082828
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Entity Type | Organization
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Legal Business Name | MID-SOUTH MINIMALLY INVASIVE OB/GYN SERVICES, PLLC
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 8065 CLUB PKWY SUITE 1
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City | CORDOVA
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State | TN
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Zip | 38016-5967
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Country | US
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Telephone | 901-729-7973
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Fax | 901-343-0491
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Provider Business Mailing Address
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Address Line | 8065 CLUB PKWY SUITE 1
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City | CORDOVA
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State | TN
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Zip | 38016-5967
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Country | US
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Telephone | 901-729-7973
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Fax | 901-343-0491
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Authorized Official
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Title or Position | OWNER
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Name | TORRANCE R. LEWIS
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Credential | MD
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Telephone | 901-729-7973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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