| Midsouth Mental Health Services, Inc | |
|
530 Oak Court Dr Suite 127 Memphis TN 38117-3726 | |
| (901) 319-4942 | |
| (901) 729-2412 |
| Full Name | Midsouth Mental Health Services, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 530 Oak Court Dr, Memphis, Tennessee |
| Authorized Official Name and Position | Michael S Seay (PRESIDENT/CEO) |
| Authorized Official Contact | 9013194942 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midsouth Mental Health Services, Inc Po Box 30727 Memphis TN 38130-0727 Ph: (901) 319-4942 | Midsouth Mental Health Services, Inc 530 Oak Court Dr Suite 127 Memphis TN 38117-3726 Ph: (901) 319-4942 |
| NPI Number | 1700103876 |
|---|---|
| Provider Enumeration Date | 04/28/2010 |
| Last Update Date | 11/05/2013 |
| Medicare PECOS PAC ID | 4587791272 |
|---|---|
| Medicare Enrollment ID | O20100429000303 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700103876 | NPI | - | NPPES |
| 1516640 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 38502 (Tennessee) | Primary |
| Provider Name | Michael B Seay |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194824771 PECOS PAC ID: 1557326410 Enrollment ID: I20041119001092 |
| Provider Name | Carolyn S Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346496379 PECOS PAC ID: 2769521301 Enrollment ID: I20091120000241 |
| Provider Name | Tareyton C Mason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225466048 PECOS PAC ID: 6608093828 Enrollment ID: I20140812002378 |
| Provider Name | Keona L Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811415201 PECOS PAC ID: 5193133262 Enrollment ID: I20210412000098 |
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