Provider Demographics
NPI:1447305206
Name:MISSISSIPPI DIAGNOSTIC IMAGING CENTER LTD
Entity type:Organization
Organization Name:MISSISSIPPI DIAGNOSTIC IMAGING CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:NANCI
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-932-3722
Mailing Address - Street 1:103 RIVER OAKS CT
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9755
Mailing Address - Country:US
Mailing Address - Phone:601-932-3722
Mailing Address - Fax:601-932-3758
Practice Address - Street 1:103 RIVER OAKS CT
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9755
Practice Address - Country:US
Practice Address - Phone:601-932-3722
Practice Address - Fax:601-932-3758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013725Medicaid
MSC00537Medicare PIN
GA300022544Medicare PIN
GAL4962Medicare PIN
MS300000176Medicare PIN