Provider Demographics
NPI:1720487820
Name:MISSISSIPPI COASTAL MRI LLC
Entity Type:Organization
Organization Name:MISSISSIPPI COASTAL MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-271-6736
Mailing Address - Street 1:PO BOX 2207
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-2207
Mailing Address - Country:US
Mailing Address - Phone:334-271-6736
Mailing Address - Fax:
Practice Address - Street 1:2900 MELTON AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-4120
Practice Address - Country:US
Practice Address - Phone:228-696-9946
Practice Address - Fax:228-696-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)