Provider Demographics
NPI:1972706521
Name:MIDSOUTH INTERNAL MEDICINE PHYSICIANS, PLLC
Entity type:Organization
Organization Name:MIDSOUTH INTERNAL MEDICINE PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAPAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-536-3201
Mailing Address - Street 1:401 SOUTHCREST CIR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6726
Mailing Address - Country:US
Mailing Address - Phone:662-536-3201
Mailing Address - Fax:662-349-2718
Practice Address - Street 1:401 SOUTHCREST CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6726
Practice Address - Country:US
Practice Address - Phone:662-536-3201
Practice Address - Fax:662-349-2718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty