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)
(901) 682-1100
Entity
Organization
Contact information
Practice address
529 N 10TH ST, BLYTHEVILLE, AR 72315-1974
(870) 762-1942
(901) 682-1100
Mailing address
PO BOX 1000 DEPT 448, MEMPHIS, TN 38148-0448
(870) 762-1942
(901) 682-6915
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158632001
—
AR
01
—
5C535
BLUE CROSS OF ARKANSAS
AR
Enumeration date
06/24/2006
Last updated
02/28/2023
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