Provider Demographics
NPI:1447680798
Name:MISSISSIPPI MEDICAL IMAGING GROUP, PLLC
Entity type:Organization
Organization Name:MISSISSIPPI MEDICAL IMAGING GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPH
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BERGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:662-840-1708
Mailing Address - Street 1:4934 PECAN DR
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-8715
Mailing Address - Country:US
Mailing Address - Phone:662-840-1708
Mailing Address - Fax:
Practice Address - Street 1:4934 PECAN DR
Practice Address - Street 2:
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-8715
Practice Address - Country:US
Practice Address - Phone:662-840-1708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-23
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS162892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty