NPIMap

Organization Active NPI

Midsouth Speciality Anesthesia Services LLC

  • Certified Registered Nurse Anesthetist
  • Germantown, TN
National Provider Identifier
1245956440
Registry record updated Dec 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
MIDSOUTH SPECIALITY ANESTHESIA SERVICES LLC
Practice address
1355 W Brierbrook Rd
Germantown, TN 38138-2208
Phone
(901) 390-2930
NPI assigned
Oct 18, 2022
Last updated
Dec 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Poppy Walker, MBA
Title
Practice Administrator
Phone
(325) 660-5535

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU Primary

Addresses

Primary practice location

1355 W Brierbrook Rd
Germantown, TN 38138-2208

Mailing address

3301 S 14TH St Ste 16180
Abilene, TX 79605-5015
Phone (325) 660-5535

Other practice location 1

403 Getwell Dr
Senatobia, MS 38668-2213
Phone (901) 390-2930

Other practice location 2

312 S Rhodes St
West Memphis, AR 72301-4215
Phone (325) 660-5535

Other practice location 3

1750 Madison Ave Ste 302
Memphis, TN 38104-6428
Phone (901) 390-2930

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, MS, TN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20221114000787 AR Part B Supplier - Clinic/Group Practice 6103293667 Receives reassigned benefits from 10 practitioners
Practice locations: West Memphis, AR
O20221114002027 MS Part B Supplier - Clinic/Group Practice 6103293667 Receives reassigned benefits from 23 practitioners
Practice locations: Senatobia, MS
O20221121000130 TN Part B Supplier - Clinic/Group Practice 6103293667 Receives reassigned benefits from 44 practitioners
Practice locations: Memphis, TN

National Provider Directory

National Provider Directory

Locations

1355 W Brierbrook Rd
Germantown, TN 38138
Phone (901) 755-8300

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 45

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670112000000",
    "number": "1245956440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 S 14TH ST STE 16180",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796055015",
            "telephone_number": "325-660-5535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 W BRIERBROOK RD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382208",
            "telephone_number": "901-390-2930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "403 Getwell Dr",
            "address_purpose": "LOCATION",
            "city": "Senatobia",
            "state": "MS",
            "postal_code": "386682213",
            "country_code": "US",
            "telephone_number": "901-390-2930",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "312 S Rhodes St",
            "address_purpose": "LOCATION",
            "city": "West Memphis",
            "state": "AR",
            "postal_code": "723014215",
            "country_code": "US",
            "telephone_number": "325-660-5535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1750 Madison Ave Ste 302",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381046428",
            "country_code": "US",
            "telephone_number": "901-390-2930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIDSOUTH SPECIALITY ANESTHESIA SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-18",
        "last_updated": "2022-12-04",
        "certification_date": "2022-12-04",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "POPPY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "325-660-5535",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.