Organization
MID-SOUTH RETINA ASSOCIATES, LLC
Active
Parent organization
MID-SOUTH RETINA ASSOCIATES, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MID-SOUTH RETINA ASSOCIATES, LLC
Authorized official
DR. RICHARD ERVIN SIEVERS M.D. (PARTNER)
(901) 682-1100
Entity
Organization
Contact information
Practice address
6005 PARK AVE, SUITE 624B, MEMPHIS, TN 38119-5202
(901) 682-1100
(901) 682-6915
Mailing address
PO BOX 1000 DEPT 448, MEMPHIS, TN 38148-0448
(901) 682-1100
(901) 682-6915
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0053763
BLUE CROSS OF TENNESSEE
TN
01
—
3066300
BLUE CROSS OF TENNESSEE
TN
01
—
3104352
BLUE CROSS OF TENNESSEE
TN
05
—
3387047
—
TN
01
—
4067262
BLUE CROSS OF TENNESSEE
TN
Enumeration date
06/23/2006
Last updated
01/28/2008
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