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
401 E TICKLE ST, DYERSBURG, TN 38024-3163
(731) 286-1240
(901) 682-6915
Mailing address
PO BOX 1000 DEPT 448, MEMPHIS, TN 38148-0448
(731) 286-1240
(901) 682-6915
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3050718
—
TN
01
—
3066300
BLUE CROSS OF TENNESSEE
TN
Enumeration date
06/24/2006
Last updated
01/28/2008
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