Provider Demographics
NPI:1114582848
Name:TOTAL IMAGING OF MISSISSIPPI
Entity Type:Organization
Organization Name:TOTAL IMAGING OF MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-917-9680
Mailing Address - Street 1:1216 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4443
Mailing Address - Country:US
Mailing Address - Phone:601-621-9696
Mailing Address - Fax:601-621-9690
Practice Address - Street 1:1216 11TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4443
Practice Address - Country:US
Practice Address - Phone:601-621-9696
Practice Address - Fax:601-621-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04031337Medicaid