Provider Demographics
NPI:1073360061
Name:MID-SOUTH VASCULAR PHYSICIANS PLLC
Entity type:Organization
Organization Name:MID-SOUTH VASCULAR PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SALIL
Authorized Official - Middle Name:SUDHIR
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-519-4690
Mailing Address - Street 1:6584 POPLAR AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-0620
Mailing Address - Country:US
Mailing Address - Phone:901-519-4690
Mailing Address - Fax:901-519-4691
Practice Address - Street 1:6584 POPLAR AVE STE 102
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-0620
Practice Address - Country:US
Practice Address - Phone:901-519-4690
Practice Address - Fax:901-519-4691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1114097615Medicaid
TN1720295660Medicaid
TN1124658380Medicaid
TN1558329169Medicaid
TN1336106681Medicaid
TN1548269517Medicaid