Provider Demographics
NPI:1730281148
Name:IMAGING CENTERS FOR EXCELLENCE, LLC
Entity Type:Organization
Organization Name:IMAGING CENTERS FOR EXCELLENCE, LLC
Other - Org Name:PREMIER IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:WYATT
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:662-620-7101
Mailing Address - Street 1:620 CROSSOVER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4944
Mailing Address - Country:US
Mailing Address - Phone:662-620-7102
Mailing Address - Fax:662-620-7106
Practice Address - Street 1:1207 HIGHWAY 182 WEST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9529
Practice Address - Country:US
Practice Address - Phone:662-320-6800
Practice Address - Fax:662-320-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06254300Medicaid
MSDF3688OtherRAILROAD MEDICARE
MSDF3688OtherRAILROAD MEDICARE