Molecular Imaging Assoc PLLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

10589 Issued in MS

Legal business name

MOLECULAR IMAGING ASSOC PLLC

Practice address

136 Fioranelli Dr
Greenville, MS 38701-7313

Phone

(662) 334-9829

Fax

(662) 334-3529

NPI assigned

Jun 5, 2007

Last updated

Jul 13, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Joe F Jacobs, MD

Title

Owner

Phone

(662) 334-9829

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342137600000",
    "number": "1679775001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 FIORANELLI DR",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387017313",
            "telephone_number": "662-334-9829",
            "fax_number": "662-334-3529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 FIORANELLI DR",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387017313",
            "telephone_number": "662-334-9829",
            "fax_number": "662-334-3529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOLECULAR IMAGING ASSOC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-05",
        "last_updated": "2012-07-13",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-334-9829",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MS",
            "license": "10589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016013",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300132286",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MS",
            "identifier": "587403483",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Diagnostic Radiology Physician in Greenville, MS
• Providers in Greenville, 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 13, 2012; 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.