Provider Demographics
NPI:1124171590
Name:MID-SOUTH CARDIOVASCULAR CENTER, LLC
Entity type:Organization
Organization Name:MID-SOUTH CARDIOVASCULAR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOMESWARA
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:KARRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-725-2222
Mailing Address - Street 1:1211 UNION AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6638
Mailing Address - Country:US
Mailing Address - Phone:901-725-2222
Mailing Address - Fax:901-725-1133
Practice Address - Street 1:1211 UNION AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6638
Practice Address - Country:US
Practice Address - Phone:901-725-2222
Practice Address - Fax:901-725-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35778207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20573241Medicaid
AR99220Medicaid
MS00125364Medicaid
TN3869275Medicaid
TN3869275Medicaid
TN3729586Medicare PIN