# MID-SOUTH CONVENIENT CARE, PLLC

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

## Provider details

- **NPI number:** 1477984508
- **Authorized official:** PANKAJ SRIVASTAVA MD (OWNER)
- **Authorized official phone:** (731) 445-4987

## Contact information

- **Practice address:** 521 HWY 51 NORTH, RIPLEY, TN 38063
- **Practice address phone:** (731) 286-6611
- **Mailing address:** 1445 US HIGHWAY 51 BYP E, SUITE B, DYERSBURG, TN 38024-2127
- **Mailing address phone:** (731) 286-1900
- **Mailing address fax:** (731) 286-1939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD0000034709 | TN | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/27/2013
- **Last updated:** 08/02/2017