| Midsouth Medicine | |
|
2149 Stateline Rd W Southaven MS 38671-1222 | |
| (662) 342-1112 | |
| (662) 342-1116 |
| Full Name | Midsouth Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 2149 Stateline Rd W, Southaven, Mississippi |
| Authorized Official Name and Position | Ciao Zheng Newman (PRESIDENT) |
| Authorized Official Contact | 6623421112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midsouth Medicine 2149 Stateline Rd W Southaven MS 38671-1222 Ph: (662) 342-1112 | Midsouth Medicine 2149 Stateline Rd W Southaven MS 38671-1222 Ph: (662) 342-1112 |
| NPI Number | 1194894147 |
|---|---|
| Provider Enumeration Date | 11/06/2006 |
| Last Update Date | 04/12/2023 |
| Medicare PECOS PAC ID | 3971579400 |
|---|---|
| Medicare Enrollment ID | O20040907000889 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194894147 | NPI | - | NPPES |
| 02207004 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 18647 (Mississippi) | Primary |
| Provider Name | Ciao Newman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922133206 PECOS PAC ID: 5092784694 Enrollment ID: I20040930000296 |
| Provider Name | Ginger Lee Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275936163 PECOS PAC ID: 9335461359 Enrollment ID: I20141202002293 |
| Provider Name | Paulette Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508308131 PECOS PAC ID: 7315227964 Enrollment ID: I20161217000015 |
| Provider Name | Courtney W Sandridge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235695768 PECOS PAC ID: 7719228360 Enrollment ID: I20190408001749 |
| Provider Name | Amy Mclennan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699246397 PECOS PAC ID: 3678816550 Enrollment ID: I20190516000523 |
| Provider Name | Shemeka Chandrae Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427642057 PECOS PAC ID: 5698182525 Enrollment ID: I20210322000672 |
| Provider Name | Elizabeth Rudman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447974159 PECOS PAC ID: 8527436799 Enrollment ID: I20221118000776 |
| Provider Name | Lana Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407552128 PECOS PAC ID: 5496127540 Enrollment ID: I20230217002613 |
| Provider Name | Dawn Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912612441 PECOS PAC ID: 7113392358 Enrollment ID: I20230331001034 |
| Provider Name | Lauren Margot Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962102087 PECOS PAC ID: 8022473453 Enrollment ID: I20230508001534 |
| Provider Name | Amanda Whitten |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568248474 PECOS PAC ID: 9830539865 Enrollment ID: I20240424002703 |
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