# MID SOUTH REGIONAL THORACIC CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164745238
- **Authorized official:** DR. MATHEW NINAN (OWNER)
- **Authorized official phone:** (901) 259-4130

## Contact information

- **Practice address:** 6029 WALNUT GROVE RD, SUITE 100, MEMPHIS, TN 38120-2112
- **Practice address phone:** (901) 259-4130
- **Practice address fax:** (901) 259-4131
- **Mailing address:** 6029 WALNUT GROVE RD, SUITE 100, MEMPHIS, TN 38120-2112
- **Mailing address phone:** (901) 259-4130
- **Mailing address fax:** (901) 259-4131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | MD5950415 | TN | Yes |

## Other

- **Enumeration date:** 03/03/2010
- **Last updated:** 03/03/2010