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General NPI Number Information
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NPI Number | 1386844504
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Entity Type | Organization
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Legal Business Name | MID-SOUTH TRANSPLANT FOUNDATION, INC.
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 8001 CENTERVIEW PKWY STE 302
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City | CORDOVA
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State | TN
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Zip | 38018-4228
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Country | US
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Telephone | 901-328-4438
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Fax | 901-328-4462
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Provider Business Mailing Address
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Address Line | 8001 CENTERVIEW PKWY STE 302
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City | CORDOVA
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State | TN
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Zip | 38018-4228
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Country | US
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Telephone | 901-328-4438
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Fax | 901-328-4462
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Authorized Official
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Title or Position | INTERIM EXECUTIVE DIRECTOR
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Name | MRS. KIM VAN FRANK
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Credential |
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Telephone | 901-328-4438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 0000002214
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License Number State | TN
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