| Mid-south Medical Management LLC | |
|
8105 Rasor Blvd Ste 120 Plano TX 75024-0336 | |
| (214) 210-0606 | |
| (855) 844-1068 |
| Full Name | Mid-south Medical Management LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 8105 Rasor Blvd Ste 120, Plano, Texas |
| Authorized Official Name and Position | Beverly Brown-harris (PRESIDENT) |
| Authorized Official Contact | 2142100606 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid-south Medical Management LLC 8105 Rasor Blvd Ste 120 Plano TX 75024-0336 Ph: (214) 210-0606 | Mid-south Medical Management LLC 8105 Rasor Blvd Ste 120 Plano TX 75024-0336 Ph: (214) 210-0606 |
| NPI Number | 1689439481 |
|---|---|
| Provider Enumeration Date | 02/20/2024 |
| Last Update Date | 06/05/2025 |
| Certification Date | 06/05/2025 |
| Medicare PECOS PAC ID | 5698217404 |
|---|---|
| Medicare Enrollment ID | O20240607003027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689439481 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Thomas Oswald Shannon |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1689781841 PECOS PAC ID: 2466492871 Enrollment ID: I20121024000522 |
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