Provider Demographics
NPI:1497820088
Name:PARKER IMAGING, LLC
Entity Type:Organization
Organization Name:PARKER IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT, RDCS
Authorized Official - Phone:662-462-5919
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:RIENZI
Mailing Address - State:MS
Mailing Address - Zip Code:38865-0002
Mailing Address - Country:US
Mailing Address - Phone:662-462-5919
Mailing Address - Fax:
Practice Address - Street 1:64 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RIENZI
Practice Address - State:MS
Practice Address - Zip Code:38865-9702
Practice Address - Country:US
Practice Address - Phone:662-462-5919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMRT1561261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09039548Medicaid