Provider Demographics
NPI:1770633166
Name:MGG IMAGING
Entity Type:Organization
Organization Name:MGG IMAGING
Other - Org Name:MEDICAL GLOBAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:520-661-7567
Mailing Address - Street 1:6455 KELMSCOT CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5674
Mailing Address - Country:US
Mailing Address - Phone:520-661-7567
Mailing Address - Fax:910-500-0879
Practice Address - Street 1:6455 KELMSCOT CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5674
Practice Address - Country:US
Practice Address - Phone:520-661-7567
Practice Address - Fax:910-500-0879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2858662471M1202X
261QM1200X, 261QR0200X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCRT0000101919OtherAZ RAD CRT
AZ285866OtherRADIOLOGY LICENSE