Basic Information
| Provider Information | |||||||||
| NPI: | 1447305206 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MISSISSIPPI DIAGNOSTIC IMAGING CENTER LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 RIVER OAKS CT | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019323722 | ||||||||
| FaxNumber: | 6019323758 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 RIVER OAKS CT | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019323722 | ||||||||
| FaxNumber: | 6019323758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PACE | ||||||||
| AuthorizedOfficialFirstName: | NANCI | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 6019323722 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | MS | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
ID Information
| ID | Type | State | Issuer | Description | 09013725 | 05 | MS | MEDICAID |