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NPI Code Detail

MEDICARE: SOUTHWIND MEDICAL SPECIALISTS, P.C.

MEDICARE: SOUTHWIND MEDICAL SPECIALISTS, P.C.
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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1912007170
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHWIND MEDICAL SPECIALISTS, P.C.
Provider Business Mailing Address
First Line : PO BOX 1000
Second Line : DEPT. 362
City : MEMPHIS
State : TN
Zip : 38148-0362
Country : US
Telephone Number : 901-373-9704
Fax Number : 901-202-8546
Provider Business Practice Location Address
First Line : 5182 SANDERLIN AVE
Second Line : SUITE 3
City : MEMPHIS
State : TN
Zip : 38117-4354
Country : US
Telephone Number : 901-685-0152
Fax Number : 901-685-9982
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : JASON BARRETT
Credential : PHD
Telephone Number : 901-367-9001
Provider Enumeration Date : 09/25/2006
Last Update Date : 11/30/2011

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