Provider Demographics
NPI:1538436167
Name:MID-SOUTH NEUROLOGY-SLEEP MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:MID-SOUTH NEUROLOGY-SLEEP MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-396-9447
Mailing Address - Street 1:5740 GETWELL RD BLDG 6
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6346
Mailing Address - Country:US
Mailing Address - Phone:662-396-9447
Mailing Address - Fax:662-396-9449
Practice Address - Street 1:5740 GETWELL RD BLDG 6
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6346
Practice Address - Country:US
Practice Address - Phone:662-396-9447
Practice Address - Fax:662-396-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS183542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty