Provider Demographics
NPI:1255427464
Name:CENTRAL MS DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:CENTRAL MS DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:STAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-270-7077
Mailing Address - Street 1:4241 VETERANS MEMORIAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5430
Mailing Address - Country:US
Mailing Address - Phone:888-273-3445
Mailing Address - Fax:504-883-5384
Practice Address - Street 1:2630 COURTHOUSE CIR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9562
Practice Address - Country:US
Practice Address - Phone:601-487-8274
Practice Address - Fax:601-487-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125434Medicaid
MS=========AOtherBLUE CROSS & BLUE SHIELD
MS470000031Medicare ID - Type Unspecified