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General NPI Number Information
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NPI Number | 1316973076
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Entity Type | Organization
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Legal Business Name | MID SOUTH RETINA ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 529 N 10TH ST
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-1974
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Country | US
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Telephone | 870-762-1942
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Fax | 901-682-1100
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Provider Business Mailing Address
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Address Line | PO BOX 1000 DEPT 448
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City | MEMPHIS
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State | TN
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Zip | 38148-0448
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Country | US
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Telephone | 870-762-1942
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Fax | 901-682-6915
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Authorized Official
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Title or Position | PARTNER
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Name | DR. RICHARD SIEVERS
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Credential | M.D.
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Telephone | 901-682-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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