Organization
MID-SOUTH RENAL CLINIC, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MASHHUD M. MIRZA M.D. (PRESIDENT)
(870) 733-1177
Entity
Organization
Contact information
Practice address
1120 STATE HIGHWAY 77 STE 1, MARION, AR 72364-9046
(870) 733-1177
(870) 702-6128
Mailing address
PO BOX 55, MARION, AR 72364-0055
(870) 733-1177
(870) 702-6128
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110217316
RAILROAD MEDICARE
—
05
—
159373002
—
AR
01
—
3154566
BLUE CROSS BLUE SHIELD
TN
01
—
5K483
BLUE CROSS BLUE SHIELD
AR
Enumeration date
08/05/2006
Last updated
05/03/2013
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up