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General NPI Number Information
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NPI Number | 1548211378
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL CARDIOLOGY OF THE MIDSOUTH, INC.
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 1211 UNION AVE SUITE 975
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City | MEMPHIS
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State | TN
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Zip | 38104-6638
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Country | US
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Telephone | 901-725-0347
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Fax | 901-725-5359
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Provider Business Mailing Address
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Address Line | MSC 410705 PO BOX 415000
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City | NASHVILLE
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State | TN
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Zip | 37241-0001
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Country | US
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Telephone | 901-725-0347
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Fax | 901-725-5359
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE J SMITH
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Credential | M.D.
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Telephone | 901-725-0347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | MD0000018928
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License Number State | TN
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