| Mid-south Infectious Disease Associates, Pllc | |
|
6029 Walnut Grove Rd Ste 209 Memphis TN 38120-2112 | |
| (901) 681-0778 | |
| (901) 821-9987 |
| Full Name | Mid-south Infectious Disease Associates, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6029 Walnut Grove Rd Ste 209, Memphis, Tennessee |
| Authorized Official Name and Position | Manoj K Jain (PRESIDENT) |
| Authorized Official Contact | 9016810778 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid-south Infectious Disease Associates, Pllc 6029 Walnut Grove Rd Ste 209 Memphis TN 38120-2112 Ph: (901) 681-0778 | Mid-south Infectious Disease Associates, Pllc 6029 Walnut Grove Rd Ste 209 Memphis TN 38120-2112 Ph: (901) 681-0778 |
| NPI Number | 1245266733 |
|---|---|
| Provider Enumeration Date | 06/25/2006 |
| Last Update Date | 01/24/2023 |
| Medicare PECOS PAC ID | 0547252124 |
|---|---|
| Medicare Enrollment ID | O20040401001700 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245266733 | NPI | - | NPPES |
| 3723463 | Medicaid | TN | |
| 009015743 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | MD0000026445 (Tennessee) | Primary |
| Provider Name | Manoj K Jain |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1003858168 PECOS PAC ID: 3072426584 Enrollment ID: I20040406000790 |
| Provider Name | Ghalib Mannan |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1831144013 PECOS PAC ID: 0345232922 Enrollment ID: I20040406000843 |
| Provider Name | Hiren S Pokharna |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1114172376 PECOS PAC ID: 5294903993 Enrollment ID: I20110726000331 |
| Provider Name | Stephanie Lyon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962940866 PECOS PAC ID: 9234416108 Enrollment ID: I20170607001004 |
| Provider Name | Inderjeet Brar |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1558777821 PECOS PAC ID: 6103124136 Enrollment ID: I20190417002272 |
| Provider Name | Dara Newberry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528584273 PECOS PAC ID: 4385903350 Enrollment ID: I20200812003621 |
| Provider Name | Amelia Margaret Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174288427 PECOS PAC ID: 7911397971 Enrollment ID: I20211206001544 |
| Provider Name | Suhel Abbas Sabunwala |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1821528134 PECOS PAC ID: 5890032163 Enrollment ID: I20220407001404 |
| Provider Name | Tuhina Cornelius |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1538680590 PECOS PAC ID: 0749676070 Enrollment ID: I20220413000941 |
| Provider Name | Elizabeth Harvey Min |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821731019 PECOS PAC ID: 4385021534 Enrollment ID: I20220510000973 |
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