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General NPI Number Information
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NPI Number | 1699987115
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF TENNESSE
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1164 WARWICK PL
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9477
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Country | US
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Telephone | 662-563-4616
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Fax |
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Provider Business Mailing Address
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Address Line | 1164 WARWICK PL
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9477
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR OB-GYN
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Name | DR. ROMERO KEITH MIDGETT
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Credential | M.D.
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Telephone | 662-536-1646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | X
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License Number State | TN
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