Organization
MID-SOUTH CONVENIENT CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PANKAJ SRIVASTAVA MD (OWNER)
(731) 445-4987
Entity
Organization
Contact information
Practice address
521 HWY 51 NORTH, RIPLEY, TN 38063
(731) 286-6611
Mailing address
1445 US HIGHWAY 51 BYP E, SUITE B, DYERSBURG, TN 38024-2127
(731) 286-1900
(731) 286-1939
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD0000034709
TN
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
11/27/2013
Last updated
08/02/2017
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