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General NPI Number Information
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NPI Number | 1245966324
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Entity Type | Organization
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Legal Business Name | MID-SOUTH IMAGING CENTER LLC
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 363 SOUTHCREST CIR STE 102
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4737
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Country | US
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Telephone | 662-772-4615
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Fax |
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Provider Business Mailing Address
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Address Line | 350 N HUMPHREYS BLVD
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City | MEMPHIS
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State | TN
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Zip | 38120-2177
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Country | US
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Telephone | 901-227-5233
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Fax |
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Authorized Official
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Title or Position | SR VP/CLO
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Name | MR. GREGORY M DUCKETT
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Credential |
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Telephone | 901-227-5233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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