Provider Demographics
NPI:1346036977
Name:MID-SOUTH DIRECT PRIMARY CARE
Entity type:Organization
Organization Name:MID-SOUTH DIRECT PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O./ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:769-223-9503
Mailing Address - Street 1:1229 MS-42 SUITE 270
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465
Mailing Address - Country:US
Mailing Address - Phone:769-223-9503
Mailing Address - Fax:601-336-4925
Practice Address - Street 1:1229 MS-42 SUITE 270
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465
Practice Address - Country:US
Practice Address - Phone:769-223-9503
Practice Address - Fax:601-336-4925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDRY HEALTHCARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care