Healthcare Provider Details

I. General information

NPI: 1992078950
Provider Name (Legal Business Name): CEDAR LAKE OPEN MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720C MEDICAL PARK DR
BILOXI MS
39532-2131
US

IV. Provider business mailing address

6300 E LAKE BLVD STE 301
VANCLEAVE MS
39565-6771
US

V. Phone/Fax

Practice location:
  • Phone: 228-354-0251
  • Fax: 228-396-3550
Mailing address:
  • Phone: 228-354-0251
  • Fax: 228-396-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LEE BOND
Title or Position: CEO
Credential:
Phone: 228-354-0251