Associated Radiologists PA
Organization Active NPI Diagnostic Radiology Physician · Brookhaven, MS
NPI 1790774263 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1790774263
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- ASSOCIATED RADIOLOGISTS PA
- Practice address
- 108 Lance Alworth Dr
Brookhaven, MS 39601-2300 - Phone
- (601) 833-6011
- Fax
- (601) 835-5413
- NPI assigned
- Oct 18, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Saundra Rena Shannon
- Title
- Office Manager
- Phone
- (601) 835-5411
Practitioners 3
-
Jani L Purvis, MD
-
Earl D Russell Jr., FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050613000391 | MS | Part B Supplier - Clinic/Group Practice | 7214971142 |
Receives reassigned benefits from 1 practitioner Practice locations: Brookhaven, MS |
National Provider Directory
Locations
950 Brookway Blvd
Brookhaven, MS 39601
Phone (601) 833-7973
108 Lance Alworth Dr
Brookhaven, MS 39601
Phone (601) 833-6011
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
108 Lance Alworth Dr
Brookhaven, MS 39601-2300
Mailing address
PO Box 764
Brookhaven, MS 39602-0764
Phone (601) 833-6011
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09011113 | Medicaid | MS |
Other providers in Brookhaven, MS
- Madison Arant
- Arjen Transportation Inc
- Kierra Armstrong
- Ascend Counseling and Consulting Services, LLC
- Aspen Properties, LLC
- Olivia Jennings Austin
- Brandon Baker
- Brandt Larue Baker
- Mac L Baker
- Bakers Pharmacy Inc
All providers in Brookhaven, 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 Aug 22, 2020. 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.