MEDICARE: MID-SOUTH HOME CARE SERVICES, LLC

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1679195028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-SOUTH HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	655 BRAWLEY SCHOOL RD STE 200
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-9601
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 S DILLARD ST STE A
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3912
Country	:	US
Telephone Number	:	407-794-8382
Fax Number	:	407-412-7575

Authorized Official
Title or Position	:	VP OF LICENUSRE
Name	:	JANET COMBS
Credential	:
Telephone Number	:	704-662-1761

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	05/16/2025

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