Provider Demographics
NPI:1710935929
Name:IMAGING CENTER OF MERIDIAN LLC
Entity Type:Organization
Organization Name:IMAGING CENTER OF MERIDIAN LLC
Other - Org Name:ORTHOPAEDIC IMAGING ASSOCIATES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-291-9161
Mailing Address - Street 1:2021 24TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3121
Mailing Address - Country:US
Mailing Address - Phone:601-483-4339
Mailing Address - Fax:601-483-4516
Practice Address - Street 1:2021 24TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3121
Practice Address - Country:US
Practice Address - Phone:601-483-4339
Practice Address - Fax:601-483-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02609273Medicaid
220258300OtherUS DEPT OF LABOR W/C
MS02609273Medicaid
=========OtherBLUE CROSS OF MS
=========OtherUNITED HEALTHCARE
=========OtherUNITED HEALTHCARE
Y18550Medicare UPIN