Medical Imaging, LLC
Organization Active NPI Diagnostic Radiology Physician · Tupelo, MS
NPI 1194772111 · NPPES record last updated Jul 9, 2013
Key facts
- NPI
- 1194772111
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- MEDICAL IMAGING, LLC
- Practice address
- 616 Crossover Rd
Tupelo, MS 38801-4944 - Phone
- (662) 620-7101
- Fax
- (662) 842-1457
- NPI assigned
- May 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Marshall Gray Edmondson, M.D.
- Title
- President
- Phone
- (662) 620-7101
Other NPIs on the same Medicare enrollment 1
Practitioners 9
-
Marshall Gray Edmondson, M.D.
-
Robert Conrad Becker, M.D.
-
Richard Kevin Cole, M.D.
-
Edward Lee Giaroli, M.D.
-
Mary Linda Moss, M.D.
-
Sarah Milam Deraney, M.D.
-
Mark L. Ellis, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041206000515 | MS | Part B Supplier - Clinic/Group Practice | 5698731271 |
Receives reassigned benefits from 25 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tupelo, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
616 Crossover Rd
Tupelo, MS 38801-4944
Mailing address
616 Crossover Rd
Tupelo, MS 38801-4944
Phone (662) 620-7101
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04984051 | Medicaid | MS | |
| 529921640 | Medicaid | AL |
Other providers in Tupelo, MS
- Jacqueline Thompson McMath
- Ginger McMillan-Buchanan
- Alicia McMillian
- Pamela McNairy
- Allison McWilliams
- Medical Imaging, LLC
- Kassidy Jean Young Medlock
- Medplus Urgent Clinic LLC
- Medvast Medical Solutions, LLC
- Syed Salman Mehdi
All providers in Tupelo, MS · Diagnostic Radiology Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.