1710935929 NPI number — IMAGING CENTER OF MERIDIAN LLC

Table of content: (NPI 1710935929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710935929 NPI number — IMAGING CENTER OF MERIDIAN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMAGING CENTER OF MERIDIAN LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ORTHOPAEDIC IMAGING ASSOCIATES LLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710935929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 24TH AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39301-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-483-4339
Provider Business Mailing Address Fax Number:
601-483-4516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 24TH AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39301-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-483-4339
Provider Business Practice Location Address Fax Number:
601-483-4516
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
G
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
337-291-9161

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02609273 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220258300 . This is a "US DEPT OF LABOR W/C" identifier . This identifiers is of the category "OTHER".




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