Provider Demographics
NPI:1578512919
Name:IMAGING ASSOCIATES OF NORTH MISSISSIPPI MAGNOLIA PLLC
Entity Type:Organization
Organization Name:IMAGING ASSOCIATES OF NORTH MISSISSIPPI MAGNOLIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CURRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-821-1831
Mailing Address - Street 1:499 GLOSTER CREEK VLG
Mailing Address - Street 2:SUITE J-7
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4600
Mailing Address - Country:US
Mailing Address - Phone:662-821-1831
Mailing Address - Fax:662-821-1815
Practice Address - Street 1:611 ALCORN DR
Practice Address - Street 2:RADIOLOGY DEPT.
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9368
Practice Address - Country:US
Practice Address - Phone:662-293-1475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016126Medicaid
349213300OtherDEPT OF LABOR PROVIDER #
CK5124OtherMEDICARE RAILROAD
349213300OtherDEPT OF LABOR PROVIDER #
MS09016126Medicaid