Mid South Senior Care, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

L000000013736 Issued in TN

Legal business name

MID SOUTH SENIOR CARE, LLC

Doing business as

Mid-South Senior Care

Practice address

5050 Poplar Ave
Suite 2400
Memphis, TN 38157-0101

Phone

(901) 766-7660

Fax

(901) 328-1353

NPI assigned

Nov 7, 2014

Last updated

Nov 7, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Chad Gilliland

Title

President

Phone

(901) 766-7660

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mid-South Senior Care Doing business as

Locations

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

{
    "created_epoch": "1415318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415318400000",
    "number": "1417353103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 POPLAR AVE",
            "address_2": "SUITE 2400",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381570101",
            "telephone_number": "901-766-7660",
            "fax_number": "901-328-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 POPLAR AVE",
            "address_2": "SUITE 2400",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381570101",
            "telephone_number": "901-766-7660",
            "fax_number": "901-328-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID SOUTH SENIOR CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-07",
        "last_updated": "2014-11-07",
        "status": "A",
        "authorized_official_last_name": "GILLILAND",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CHAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-766-7660",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "TN",
            "license": "L000000013736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H445514",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid-South Senior Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mid South Residential Care Center
• Mid South Supportive Living, LLC
• Mid South Vascular Clinic
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• Mid-South Cardiovascular Center, LLC

• In Home Supportive Care Agency in Memphis, TN
• Providers in Memphis, TN by specialty
• In Home Supportive Care Agency in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.