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General NPI Number Information
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NPI Number | 1770633166
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Entity Type | Organization
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Legal Business Name | MGG IMAGING
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 6455 KELMSCOT CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5674
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Country | US
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Telephone | 520-661-7567
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Fax | 910-500-0879
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Provider Business Mailing Address
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Address Line | 6455 KELMSCOT CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5674
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Country | US
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Telephone | 520-661-7567
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Fax | 910-500-0879
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL G GILBERT SR.
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Credential |
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Telephone | 520-661-7567
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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 |
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Taxonomy #2
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2471M1202X
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Taxonomy Name | Magnetic Resonance Imaging Radiologic Technologist
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License Number | 285866
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License Number State | AZ
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