Healthcare Provider Details

I. General information

NPI: 1083613699
Provider Name (Legal Business Name): IMAGING CENTER OF COLUMBUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 5TH ST N
COLUMBUS MS
39705-2019
US

IV. Provider business mailing address

2526 5TH ST N
COLUMBUS MS
39705-2019
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-8402
  • Fax: 662-328-1554
Mailing address:
  • Phone: 662-328-8402
  • Fax: 662-328-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK G. HOWARD
Title or Position: MANAGING MEMBER
Credential:
Phone: 337-291-9161