Organization
MID-SOUTH RECTAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL M. FOX M.D. (PROVIDER/OWNER)
(901) 362-5252
Entity
Organization
Contact information
Practice address
6563 STAGE OAKS DR, SUITE 100, BARTLETT, TN 38134-2886
(901) 362-5252
(901) 369-4775
Mailing address
7550 LUCERNE DR, SUITE 405, MIDDLEBURG HEIGHTS, OH 44130-6588
(440) 234-8833
(440) 234-3313
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
36972
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01702559
—
MS
05
—
155546001
—
AK
05
—
3727193
—
TN
Enumeration date
11/01/2006
Last updated
02/01/2016
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