Mid Delta Radiology Associates, LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

E7789 Issued in AR

Legal business name

MID DELTA RADIOLOGY ASSOCIATES, LLC

Practice address

130 River Club Cir
Clarksdale, MS 38614-9725

Phone

(662) 832-3514

Fax

(866) 782-0773

NPI assigned

Sep 11, 2012

Organization subpart

No

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

Authorized official

Name

Kelley Oliver

Title

Manager

Phone

(662) 832-3514

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS, AR2 enrollments

Enrollment records 2

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph A Oliver, M.D.

  • Diagnostic Radiology Physician
  • Jackson, MS
  • NPI 1699798306

  AR

  Medicare reassignment NPD
• John Andrew Oliver, M.D.

  • Diagnostic Radiology Physician
  • Helena, AR
  • NPI 1073775466

  MS, Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1487904173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 RIVER CLUB CIR",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386149725",
            "telephone_number": "662-832-3514",
            "fax_number": "866-782-0773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 RIVER CLUB CIR",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386149725",
            "telephone_number": "662-832-3514",
            "fax_number": "866-782-0773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID DELTA RADIOLOGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-11",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "662-832-3514"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AR",
            "license": "E7789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209761002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Medical Oncology Inc
• Carrie Cope Melton
• Memorial Hospice Inc
• Ramon Merritte
• Eric H Messenger
• Mid South Chiropractic of Clarksdale PLLC
• Mid-Delta Home Health of Charleston, Inc.
• Desirea Miller, MSW
• Monica D Miller, M.ED.
• Tonjia Marie Miller, SW

• Diagnostic Radiology Physician in Clarksdale, MS
• Providers in Clarksdale, MS by specialty
• Diagnostic Radiology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.