Basic Information
| Provider Information | |||||||||
| NPI: | 1336862952 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MSK GROUP, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6077 PRIMACY PKWY STE 140 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381195754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012591673 | ||||||||
| FaxNumber: | 9012597637 | ||||||||
| Practice Location | |||||||||
| Address1: | 13690 HIGHWAY 51 S STE 104 | ||||||||
| Address2: | |||||||||
| City: | ATOKA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380047645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016413000 | ||||||||
| FaxNumber: | 9013730804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2022 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | FLEMING | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9017258347 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MSK GROUP, PC | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.