Healthcare Provider Details

I. General information

NPI: 1639821416
Provider Name (Legal Business Name): MP IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8541 FM 2021
LUFKIN TX
75904-8968
US

IV. Provider business mailing address

8541 FM 2021
LUFKIN TX
75904-8968
US

V. Phone/Fax

Practice location:
  • Phone: 936-404-2566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MONICA LINDSEY PHILLIPS
Title or Position: OWNER
Credential: RDMS, RVT
Phone: 936-404-2566