Healthcare Provider Details

I. General information

NPI: 1710935929
Provider Name (Legal Business Name): IMAGING CENTER OF MERIDIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 24TH AVE SUITE B
MERIDIAN MS
39301-3121
US

IV. Provider business mailing address

4241 VETERANS MEMORIAL BLVD STE 200
METAIRIE LA
70006-5430
US

V. Phone/Fax

Practice location:
  • Phone: 601-483-4339
  • Fax: 601-483-4516
Mailing address:
  • Phone: 504-459-3201
  • Fax: 504-883-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN P STAGG
Title or Position: CEO
Credential:
Phone: 225-270-7077