NPIMap

Organization Active NPI

Mid-South Retina Associates, LLC

  • Ophthalmology Physician
  • Olive Branch, MS
National Provider Identifier
1639891088
Registry record updated Oct 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MID-SOUTH RETINA ASSOCIATES, LLC
Practice address
6760 Goodman Rd Ste 125
Olive Branch, MS 38654-7056
Phone
(901) 682-1100
Fax
(731) 265-2913
NPI assigned
Sep 13, 2022
Last updated
Oct 19, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MID-SOUTH RETINA ASSOCIATES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2022

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

Authorized official

Name
Brian Bradberry
Title
Practice Administrator
Phone
(731) 427-7799

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

6760 Goodman Rd Ste 125
Olive Branch, MS 38654-7056

Mailing address

PO Box 1000 Dept 448
Memphis, TN 38148-0001
Phone (901) 682-1100

National Provider Directory

National Provider Directory
Tax ID family
Mid-South Retina Associat8 organizations share this tax ID, including this one
Part of
Mid-South Retina Associat

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666137600000",
    "number": "1639891088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000 DEPT 448",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381480001",
            "telephone_number": "901-682-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6760 GOODMAN RD STE 125",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547056",
            "telephone_number": "901-682-1100",
            "fax_number": "731-265-2913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-SOUTH RETINA ASSOCIATES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MID-SOUTH RETINA ASSOCIATES, LLC",
        "enumeration_date": "2022-09-13",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A",
        "authorized_official_last_name": "BRADBERRY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "731-427-7799"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olive Branch, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; 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.