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	261QE0002X	Emergency Care Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1780017228
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	:	901-421-5000
Fax Number	:	901-572-1241

Provider Business Practice Location Address
First Line	:	1204 N HOUSTON LEVEE RD
Second Line	:	SUITE 114
City	:	CORDOVA
State	:	TN
Zip	:	38018-6687
Country	:	US
Telephone Number	:	901-421-5000
Fax Number	:	901-572-1241

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOHAMMED BAH
Credential	:	MD
Telephone Number	:	901-421-5000

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	09/24/2024

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