Healthcare Provider Details

I. General information

NPI: 1003968595
Provider Name (Legal Business Name): MADISON RADIOLOGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 RIVER OAKS DR
CANTON MS
39046-5375
US

IV. Provider business mailing address

PO BOX 4767
JACKSON MS
39296-4767
US

V. Phone/Fax

Practice location:
  • Phone: 601-855-4000
  • Fax: 601-855-4330
Mailing address:
  • Phone: 601-982-7878
  • Fax: 601-982-7909

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: JOSEPH A OLIVER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 601-855-4000