Provider Demographics
NPI:1780608331
Name:MID-SOUTH PERINATAL ASSOCIATES PC
Entity type:Organization
Organization Name:MID-SOUTH PERINATAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOELDTKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-541-6836
Mailing Address - Street 1:P.O. BOX 11505
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308
Mailing Address - Country:US
Mailing Address - Phone:731-541-6939
Mailing Address - Fax:731-541-6836
Practice Address - Street 1:620 SKYLINE DR.
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301
Practice Address - Country:US
Practice Address - Phone:731-541-6939
Practice Address - Fax:731-541-6836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380815Medicare ID - Type UnspecifiedMEDICARE