Healthcare Provider Details

I. General information

NPI: 1811932577
Provider Name (Legal Business Name): TENET GULF COAST IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975A CEDAR LAKE RD SUITE 150
BILOXI MS
39532-2128
US

IV. Provider business mailing address

PO BOX 676764
DALLAS TX
75267-6764
US

V. Phone/Fax

Practice location:
  • Phone: 228-395-1601
  • Fax:
Mailing address:
  • Phone: 228-396-1601
  • Fax: 228-392-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL KYLE BURTNETT
Title or Position: VSVP OF OUTPATIENT SERVICES, TENET
Credential:
Phone: 469-893-2153