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 SIEVERS M.D. (PARTNER)
(800) 221-7892
Entity
Organization
Contact information
Practice address
300 S 8TH ST, SUITE 284W, MURRAY, KY 42071-2400
(800) 221-7892
(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
—
000000261767
ANTHEM BLUE CROSS
KY
05
—
64721467
—
KY
Enumeration date
06/18/2006
Last updated
10/19/2007
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