Southaven Internal Medicine, P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SOUTHAVEN INTERNAL MEDICINE, P.C.

Practice address

7680 Airways Blvd
Southaven, MS 38671-5304

Phone

(662) 349-1999

Fax

(662) 349-9734

NPI assigned

Jan 10, 2007

Organization subpart

No

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

Authorized official

Name

Kandis P Sledge

Title

Office Manager

Phone

(662) 349-1999

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary S Missak, M.D.

  • Internal Medicine Physician
  • Southaven, MS
  • NPI 1962507061
  Medicare reassignment Care Compare group NPD
• Magdi S Wassef, M.D.

  • Internal Medicine Physician
  • Southaven, MS
  • NPI 1275638363
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276732800000",
    "number": "1932259355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7680 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715304",
            "telephone_number": "662-349-1999",
            "fax_number": "662-349-9734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7680 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715304",
            "telephone_number": "662-349-1999",
            "fax_number": "662-349-9734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHAVEN INTERNAL MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2010-06-17",
        "status": "A",
        "authorized_official_last_name": "SLEDGE",
        "authorized_official_first_name": "KANDIS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "662-349-1999"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015446",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Soledad Garcia
• Cory Gary Solowsky
• Katharine Rhodes Sorenson, KATHARINE SORENSON
• Soulshine Counseling and Wellness, LLC
• Southaven Hearing Health Center LLP
• Southaven Services
• Southaven Sleep Clinic
• Southaven Surgery Center LLC
• Southcrest Anesthesia Services, PLLC
• Southcrest Women Healthcare

• Internal Medicine Physician in Southaven, MS
• Providers in Southaven, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.