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General NPI Number Information
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NPI Number | 1255427464
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Entity Type | Organization
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Legal Business Name | CENTRAL MS DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 2630 COURTHOUSE CIR
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City | FLOWOOD
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State | MS
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Zip | 39232-9562
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Country | US
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Telephone | 601-487-8274
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Fax | 601-487-8701
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Provider Business Mailing Address
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Address Line | 4241 VETERANS MEMORIAL BLVD STE 200
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City | METAIRIE
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State | LA
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Zip | 70006-5430
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Country | US
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Telephone | 888-273-3445
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Fax | 504-883-5384
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Authorized Official
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Title or Position | CEO
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Name | JOHN P STAGG
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Credential |
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Telephone | 225-270-7077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | MS
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