Organization
MID-SOUTH GASTROENTEROLOGY GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SEANDRIA F ECHOLS (DIRECTOR OF OPERATIONS)
(901) 272-7200
Entity
Organization
Contact information
Practice address
1417 MONROE AVE, MEMPHIS, TN 38104-3634
(901) 272-7200
(901) 260-5916
Mailing address
1417 MONROE AVE, MEMPHIS, TN 38104-3634
(901) 272-7200
(901) 260-5916
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000101
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3287965
—
TN
Enumeration date
08/22/2006
Last updated
11/19/2008
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