Provider Demographics
NPI:1588120943
Name:MID-SOUTH REHABILITATION & RESTORATIVE MEDICINE PLLC
Entity type:Organization
Organization Name:MID-SOUTH REHABILITATION & RESTORATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-377-1370
Mailing Address - Street 1:609 BRUNSON DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4948
Mailing Address - Country:US
Mailing Address - Phone:662-377-1370
Mailing Address - Fax:662-377-1379
Practice Address - Street 1:609 BRUNSON DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4948
Practice Address - Country:US
Practice Address - Phone:662-377-1370
Practice Address - Fax:662-377-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty