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General NPI Number Information
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NPI Number | 1184624454
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Entity Type | Organization
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Legal Business Name | MID-SOUTH CANCER CENTER
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8000 WOLF RIVER BLVD SUITE 100
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City | GERMANTOWN
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State | TN
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Zip | 38138-1727
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Country | US
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Telephone | 901-763-0446
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Fax | 901-763-0042
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Provider Business Mailing Address
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Address Line | PO BOX 1000 DPT 242
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City | MEMPHIS
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State | TN
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Zip | 38148-0242
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Country | US
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Telephone | 901-763-0446
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Fax | 901-763-0042
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Authorized Official
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Title or Position | BUSINESS OFFICE ASSISTANT MANAGER
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Name | NATALYA KUSHNIR
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Credential |
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Telephone | 901-763-0446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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