Provider Demographics
NPI:1447299896
Name:SOUTHWIND MEDICAL SPECIALISTS, P. C.
Entity type:Organization
Organization Name:SOUTHWIND MEDICAL SPECIALISTS, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-367-9001
Mailing Address - Street 1:P. O. BOX 1000 DEPT 362
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-373-9704
Mailing Address - Fax:901-255-5223
Practice Address - Street 1:3725 CHAMPION HILLS DR
Practice Address - Street 2:SUITE 2000
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2597
Practice Address - Country:US
Practice Address - Phone:901-367-9001
Practice Address - Fax:901-565-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH3787OtherRAIL ROAD MEDICARE
AR149748002Medicaid
AR8P085OtherBCBS
=========OtherTRICARE
AR8P085OtherBCBS
AR149748002Medicaid