Healthcare Provider Details

I. General information

NPI: 1447305206
Provider Name (Legal Business Name): MISSISSIPPI DIAGNOSTIC IMAGING CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 RIVER OAKS CT
FLOWOOD MS
39232-9755
US

IV. Provider business mailing address

103 RIVER OAKS CT
FLOWOOD MS
39232-9755
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-3722
  • Fax: 601-932-3758
Mailing address:
  • Phone: 601-932-3722
  • Fax: 601-932-3758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NANCI PACE
Title or Position: ADMINISTRATION
Credential:
Phone: 601-932-3722