Provider Demographics
NPI:1346339694
Name:RADIOLOGY ASSOCIATES OF NATCHEZ, P.A.
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF NATCHEZ, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICKI
Authorized Official - Middle Name:WISE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-442-5042
Mailing Address - Street 1:307 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4610
Mailing Address - Country:US
Mailing Address - Phone:601-442-5042
Mailing Address - Fax:601-442-5052
Practice Address - Street 1:307 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4610
Practice Address - Country:US
Practice Address - Phone:601-442-5042
Practice Address - Fax:601-442-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09011638Medicaid
LA1111058Medicaid
LA5D798Medicare PIN
MS09011638Medicaid
MSC00255Medicare PIN