Organization
MID-SOUTH IMAGING & THERAPEUTICS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN A ELLZEY MD (PRESIDENT)
(901) 473-6406
Entity
Organization
Contact information
Practice address
7600 WOLF RIVER BLVD., #200, GERMANTOWN, TN 38138
(901) 747-1000
(901) 747-1001
Mailing address
PO BOX 5083, MEMPHIS, TN 38101-5083
(901) 383-8860
(901) 383-8985
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0022687
GROUP TN BCBS #
TN
05
—
09013816
—
MS
05
—
107365002
—
AR
05
—
3373325
—
TN
05
—
508212206
—
MO
01
—
86018
GROUP AR BCBS #
AR
Enumeration date
05/11/2006
Last updated
10/16/2024
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