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DESOTO DIAGNOSTIC IMAGING LLC NPI 1083777882


NPI Information

NPI: 1083777882
Provider Name: DESOTO DIAGNOSTIC IMAGING, LLC

Doing Business As: METHODIST DIAGNOSTIC CENTER, LLC

Classification: Radiologic Technologist - 2471M1202X
Entity Type: Organization

Specialization: Magnetic Resonance Imaging

Address:
9085 SANDIDGE CENTER COVE
SUITE 100
OLIVE BRANCH, MS
ZIP 38654
Phone: (662) 536-1000
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DESOTO DIAGNOSTIC IMAGING, LLC is a magnetic resonance imaging radiologic technologist in Olive Branch, MS. The provider is a radiologic technologist who specializes in magnetic resonance imaging (MRI) and is appropriately educated and trained, consistent with nationally recognized standards, state statute, and facility policy in performance of MRIs, exam techniques, equipment protocols, radiation safety, and patient care. DESOTO DIAGNOSTIC IMAGING, LLC NPI is 1083777882. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Methodist Diagnostic Center, Llc.

The provider's business location address is:

9085 SANDIDGE CENTER COVE
SUITE 100
OLIVE BRANCH, MS
ZIP 38654-575
Phone: (662) 536-1000
Fax: (662) 893-8824

The provider's authorized official is John M Graves .
The authorized official title is President and has the following contact phone number (901) 516-1410.

The enumeration date for this NPI number is 12/19/2006 and was last updated on 11/30/2011.


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:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12471C3401XRadiologic TechnologistComputed TomographyNo
22471C3402XRadiologic TechnologistRadiographyNo
32471M2300XRadiologic TechnologistMammographyNo
42471N0900XRadiologic TechnologistNuclear Medicine TechnologyNo
52471S1302XRadiologic TechnologistSonographyNo
62471V0105XRadiologic TechnologistVascular SonographyNo
72471M1202XRadiologic TechnologistMagnetic Resonance ImagingYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100973276MEDICAIDMISSISSIPPI
2C03266MEDICARE OSCAR/CERTIFICATIONMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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