MEDICARE: MID-SOUTH URGENT CARE, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1326741844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-SOUTH URGENT CARE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 5165
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38101-5165
Country	:	US
Telephone Number	:	901-779-8657
Fax Number	:	901-791-4208

Provider Business Practice Location Address
First Line	:	5905 STAGE RD
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-4521
Country	:	US
Telephone Number	:	901-779-8657
Fax Number	:	901-791-4208

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOHAMMED BAH
Credential	:	MD
Telephone Number	:	901-821-0338

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	09/24/2024

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