IMAGINE LLC NPI 1902052962

NPI Information

IMAGINE, LLC is a mental health (including community mental health center) clinic center in Jackson, MS. IMAGINE, LLC NPI is 1902052962. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1920 DUNBARTON DR
JACKSON, MS
ZIP 39216-001
Phone: (601) 982-5376
Fax: (601) 982-5377

The provider's authorized official is Baxter Hugh Hogue .
The authorized official title is President and has the following contact phone number (601) 259-4081.

The CLIA number assigned to this NPI record is 25D2116428 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/11/2008 and was last updated on 10/18/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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