NPIMap

Organization Active NPI

Southern Medical Imaging

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Hattiesburg, MS
National Provider Identifier
1407008972
Registry record updated Oct 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
SOUTHERN MEDICAL IMAGING
Practice address
1 Lincoln Pkwy
Suite 105
Hattiesburg, MS 39402-3262
Phone
(601) 579-4463
NPI assigned
Oct 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2008

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

Authorized official

Name
Shelley Gendusa
Title
Office Manager
Phone
(601) 579-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X Primary

Addresses

Primary practice location

1 Lincoln Pkwy
Suite 105
Hattiesburg, MS 39402-3262

Mailing address

1 Lincoln Pkwy
Suite 105
Hattiesburg, MS 39402-3262

Other identifiers 1

IdentifierTypeStateIssuer
09008521MedicaidMS

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1407008972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LINCOLN PKWY",
            "address_2": "SUITE 105",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LINCOLN PKWY",
            "address_2": "SUITE 105",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023262",
            "telephone_number": "601-579-4463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MEDICAL IMAGING",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-16",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "GENDUSA",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "601-579-4500"
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09008521",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; 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.