Provider Demographics
NPI:1487715736
Name:MEDICINE AND OBSTETRIC ASSOCIATES OF THE MIDSOUTH PLLC
Entity type:Organization
Organization Name:MEDICINE AND OBSTETRIC ASSOCIATES OF THE MIDSOUTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-763-0833
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-763-0833
Mailing Address - Fax:901-763-3831
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-763-0833
Practice Address - Fax:901-763-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD25714174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3886338Medicare ID - Type UnspecifiedANGELA MICHELLE CULBRETH
TNH88724Medicare UPIN
TN3331424Medicare ID - Type UnspecifiedRUCHIKA SHARMA
TNF92102Medicare UPIN
TNI32339Medicare UPIN
TN3086785Medicare ID - Type UnspecifiedGILBERT THAYER