Jeremy S King – Body Imaging Physician in Winona, MS

Key facts

NPI: 1821877903
Entity type: Individual (NPI type 1)
Primary specialty: Body Imaging Physician 2085B0100X
License: MRT-6515 (MS)
Practice address: 511 Herod Dr
Winona, MS 38967-1509
Phone: (662) 417-6272
NPI assigned: Sep 27, 2023
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Radiology on the Run LLC Radiologic Technologist · Winona, MS · NPI 1538931514

NPD Authorized official

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
MRT-6515	MS	MD	Body Imaging Physician

Practice roles

Organization	Specialty	Status	New patients
Radiology on the Run LLC		Current since Oct 29, 2023	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Body Imaging Physician	2085B0100X	MRT-6515	MS	Yes

Addresses

Primary practice location

511 Herod Dr
Winona, MS 38967-1509

Mailing address

511 Herod Dr
Winona, MS 38967-1509
Phone (662) 417-6272

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 27, 2023.

{
    "created_epoch": "1695772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1821877903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 HEROD DR",
            "city": "WINONA",
            "state": "MS",
            "postal_code": "389671509",
            "telephone_number": "662-417-6272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 HEROD DR",
            "city": "WINONA",
            "state": "MS",
            "postal_code": "389671509",
            "telephone_number": "662-417-6272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "JEREMY",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-27",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "MS",
            "license": "MRT-6515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winona, MS

All providers in Winona, MS · Body Imaging 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 Sep 27, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.