Basic Information
| Provider Information | |||||||||
| NPI: | 1083898605 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC | ||||||||
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| OtherOrganizationName: | MIDSOUTH PAIN TREATMENT CENTER, LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1365 W BRIERBROOK RD | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381382208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016246517 | ||||||||
| FaxNumber: | 9016246521 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 AIRWAYS PL | ||||||||
| Address2: | |||||||||
| City: | SOUTHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386715872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623499990 | ||||||||
| FaxNumber: | 6623492620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2007 | ||||||||
| LastUpdateDate: | 04/25/2017 | ||||||||
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| AuthorizedOfficialLastName: | STEUER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9016246517 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 1703 | MS | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.