MEDICARE: MID-SOUTH CANCER CENTER

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5F008	OTHER	AR	BC OF AR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4078501	OTHER	TN	BCBS

NPI Number	:	1184624454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-SOUTH CANCER CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1000
Second Line	:	DPT 242
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0242
Country	:	US
Telephone Number	:	901-763-0446
Fax Number	:	901-763-0042

Provider Business Practice Location Address
First Line	:	8000 WOLF RIVER BLVD
Second Line	:	SUITE 100
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-1727
Country	:	US
Telephone Number	:	901-763-0446
Fax Number	:	901-763-0042

Authorized Official
Title or Position	:	BUSINESS OFFICE ASSISTANT MANAGER
Name	:	NATALYA KUSHNIR
Credential	:
Telephone Number	:	901-763-0446

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/22/2020

8060 WOLF RIVER BLVD
GERMANTOWN, TN
38138-1727

Practice Phone: 901-271-1000
Practice Fax:

8000 WOLF RIVER BLVD , SUITE 200
GERMANTOWN, TN
38138-1727