| Midsouth Independent Group, Pllc | |
|
6401 Poplar Ave Ste 604 Memphis TN 38119-4808 | |
| (901) 474-2402 | |
| (901) 328-5746 |
| Full Name | Midsouth Independent Group, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6401 Poplar Ave Ste 604, Memphis, Tennessee |
| Authorized Official Name and Position | William R Breen (GROUP MANAGER) |
| Authorized Official Contact | 9018324494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midsouth Independent Group, Pllc 6401 Poplar Ave Ste 604 Memphis TN 38119-4808 Ph: (901) 474-2402 | Midsouth Independent Group, Pllc 6401 Poplar Ave Ste 604 Memphis TN 38119-4808 Ph: (901) 474-2402 |
| NPI Number | 1861009326 |
|---|---|
| Provider Enumeration Date | 09/29/2020 |
| Last Update Date | 11/29/2023 |
| Medicare PECOS PAC ID | 2668886722 |
|---|---|
| Medicare Enrollment ID | O20210201001564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861009326 | NPI | - | NPPES |
| Q061176 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Charles R Handorf |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1174507289 PECOS PAC ID: 8123009073 Enrollment ID: I20041012000665 |
| Provider Name | Jaya Venkataraman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1487654752 PECOS PAC ID: 6204896574 Enrollment ID: I20041012001215 |
| Provider Name | Tamara L Howard-fain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932262417 PECOS PAC ID: 5799737789 Enrollment ID: I20050217000897 |
| Provider Name | Lloyd E Robinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265534184 PECOS PAC ID: 0547240103 Enrollment ID: I20050511000277 |
| Provider Name | Terrye T Mastin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730110693 PECOS PAC ID: 2466488291 Enrollment ID: I20050713000678 |
| Provider Name | Keener B Ragsdale |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1730175043 PECOS PAC ID: 7113024597 Enrollment ID: I20070518000467 |
| Provider Name | James O Patterson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1457352106 PECOS PAC ID: 7214038645 Enrollment ID: I20070728000265 |
| Provider Name | Barbara Geater |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679509707 PECOS PAC ID: 6901993989 Enrollment ID: I20071108000037 |
| Provider Name | Paul W Hutchison |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1891743241 PECOS PAC ID: 7113016759 Enrollment ID: I20071204000521 |
| Provider Name | Judy G Cole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952454332 PECOS PAC ID: 1355429598 Enrollment ID: I20080429000157 |
| Provider Name | Linda A Foster |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528055381 PECOS PAC ID: 0941391817 Enrollment ID: I20081114000175 |
| Provider Name | Mohamad K Moughrabieh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063679827 PECOS PAC ID: 6406917269 Enrollment ID: I20090610000024 |
| Provider Name | Shawn J Hayden |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609835909 PECOS PAC ID: 9335299189 Enrollment ID: I20090616000814 |
| Provider Name | Laura N Lendermon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053326876 PECOS PAC ID: 1658339189 Enrollment ID: I20100312000091 |
| Provider Name | Monisha Dutta |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164634978 PECOS PAC ID: 3678601044 Enrollment ID: I20100505000339 |
| Provider Name | Kimberly Randolph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144544982 PECOS PAC ID: 8820128028 Enrollment ID: I20100615000470 |
| Provider Name | Joy Carol Burbeck |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1578569034 PECOS PAC ID: 1153453576 Enrollment ID: I20100721000435 |
| Provider Name | Paul Jay Katz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497753131 PECOS PAC ID: 8628120391 Enrollment ID: I20100913000079 |
| Provider Name | Susan N Lacy |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1710998729 PECOS PAC ID: 8426242355 Enrollment ID: I20101104000284 |
| Provider Name | Michelle James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750536967 PECOS PAC ID: 0749475820 Enrollment ID: I20101115000938 |
| Provider Name | Angela B Cursey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912007469 PECOS PAC ID: 6901092592 Enrollment ID: I20101122000654 |
| Provider Name | Barbara P Evangelisti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871700658 PECOS PAC ID: 7214199579 Enrollment ID: I20120502000437 |
| Provider Name | Patricia Ar Arangie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114043791 PECOS PAC ID: 8527210913 Enrollment ID: I20121211000356 |
| Provider Name | Jennifer Potts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649688987 PECOS PAC ID: 3476774043 Enrollment ID: I20141023001224 |
| Provider Name | Zehra Jaffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346598026 PECOS PAC ID: 4385967389 Enrollment ID: I20150107000207 |
| Provider Name | Nykkia Sellers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134316250 PECOS PAC ID: 6204019649 Enrollment ID: I20151110000662 |
| Provider Name | Tracy W Rapp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720451545 PECOS PAC ID: 4082914122 Enrollment ID: I20151123000776 |
| Provider Name | Jessica Robbins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306200738 PECOS PAC ID: 1951695147 Enrollment ID: I20160810002879 |
| Provider Name | Krystal Boyland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093250318 PECOS PAC ID: 2769752351 Enrollment ID: I20170713002863 |
| Provider Name | Farah F Cardosi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235667965 PECOS PAC ID: 2163794256 Enrollment ID: I20170824001671 |
| Provider Name | Jeremy Hubbard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033638499 PECOS PAC ID: 6406104835 Enrollment ID: I20180801002363 |
| Provider Name | Mallory Dixon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396224754 PECOS PAC ID: 0042562191 Enrollment ID: I20181017003615 |
| Provider Name | Cherechi C Ogwo |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1720321060 PECOS PAC ID: 8729226600 Enrollment ID: I20190829004381 |
| Provider Name | Phuongdinh Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588911036 PECOS PAC ID: 2668806571 Enrollment ID: I20200101000018 |
| Provider Name | Melinda H Olds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467002691 PECOS PAC ID: 2961811955 Enrollment ID: I20210504000116 |
| Provider Name | Kimberlie A Simpson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013593383 PECOS PAC ID: 1052710647 Enrollment ID: I20210602001290 |
| Provider Name | Saul M Greenbaum |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1851707616 PECOS PAC ID: 8729355029 Enrollment ID: I20211025001884 |
| Provider Name | Jasmine S Roberson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427718022 PECOS PAC ID: 3072906262 Enrollment ID: I20220211000129 |
| Provider Name | Adam Benjamin Libby |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1639732126 PECOS PAC ID: 2062894447 Enrollment ID: I20220802000364 |
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Jerry M Holley Md Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4100 Austin Peay Hwy, Memphis, TN 38128 Phone: 901-486-1151 Fax: 901-844-1439 | |
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