Organization
MID-SOUTH NEPHROLOGY CONSULTANTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINGA HERNANDEZ (CHIEF EXECUTIVE OFFICER)
(901) 565-0244
Entity
Organization
Contact information
Practice address
6490 MOUNT MORIAH ROAD EXT STE 200, MEMPHIS, TN 38115-3841
(901) 565-0244
(901) 565-0616
Mailing address
6490 MOUNT MORIAH ROAD EXT STE 200, MEMPHIS, TN 38115-3841
(901) 565-0244
(901) 565-0616
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09983030
—
MS
05
—
152287002
—
AR
05
—
208992305
—
MO
05
—
3373435
—
TN
01
—
4030327
BLUE CROSS BLUE SHIELD
TN
01
—
5B527
BLUE CROSS BLUE SHIELD
AR
Enumeration date
03/14/2006
Last updated
02/29/2012
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