Provider Demographics
NPI:1366721177
Name:MID SOUTH HEALTH CARE, PLLC
Entity type:Organization
Organization Name:MID SOUTH HEALTH CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-708-8886
Mailing Address - Street 1:1028 N. MISSOURI
Mailing Address - Street 2:STE 7
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301
Mailing Address - Country:US
Mailing Address - Phone:870-735-0600
Mailing Address - Fax:870-735-0608
Practice Address - Street 1:1028 N. MISSOURI
Practice Address - Street 2:STE 7
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301
Practice Address - Country:US
Practice Address - Phone:870-735-0600
Practice Address - Fax:870-735-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty