Desoto Diagnostic Imaging, LLC

Primary specialty

Magnetic Resonance Imaging Radiologic TechnologistTaxonomy code 2471M1202X

Legal business name

DESOTO DIAGNOSTIC IMAGING, LLC

Practice address

9085 Sandidge Center Cove
Suite 100
Olive Branch, MS 38654-3575

Phone

(662) 536-1000

Fax

(662) 893-8824

NPI assigned

Dec 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John M Graves

Title

President

Phone

(901) 516-1410

Specialties & licenses 7

Addresses

Other identifiers 1

Other names 1

• Methodist Diagnostic Center, LLC Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Methodist Heatlhcare Community Care Associates

  • Urgent Care Clinic/Center
  • Memphis, TN
  • NPI 1124277967

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1083777882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9085 SANDIDGE CENTER COVE",
            "address_2": "SUITE 100",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386543575",
            "telephone_number": "662-536-1000",
            "fax_number": "662-893-8824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9085 SANDIDGE CENTER COVE",
            "address_2": "SUITE 100",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386543575",
            "telephone_number": "662-536-1000",
            "fax_number": "662-893-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESOTO DIAGNOSTIC IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-516-1410"
    },
    "taxonomies": [
        {
            "code": "2471C3401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Computed Tomography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471C3402X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Radiography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471M1202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Magnetic Resonance Imaging",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2471M2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Mammography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471N0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Nuclear Medicine Technology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471S1302X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Sonography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471V0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Vascular Sonography",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00973276",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Methodist Diagnostic Center, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Olive Branch, MS
• Magnetic Resonance Imaging Radiologic Technologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.