Healthcare Provider Details

I. General information

NPI: 1396762209
Provider Name (Legal Business Name): SINGING RIVER RADIOLOGY GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 DENNY AVE
PASCAGOULA MS
39581-5301
US

IV. Provider business mailing address

1365 MARKET ST
PASCAGOULA MS
39567-6604
US

V. Phone/Fax

Practice location:
  • Phone: 228-762-1353
  • Fax:
Mailing address:
  • Phone: 228-762-1353
  • Fax: 228-762-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LUJEAN TRUMBLE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 228-762-1353