| Grenada Diagnostic Radiology | |
|
1300 Sunset Dr Suite U Grenada MS 38901-4086 | |
| (662) 226-9279 | |
| (662) 226-9779 |
| Full Name | Grenada Diagnostic Radiology |
|---|---|
| Speciality | Clinic/center |
| Location | 1300 Sunset Dr, Grenada, Mississippi |
| Authorized Official Name and Position | Ralph C Armstrong (ADMINISTRATOR) |
| Authorized Official Contact | 6622269279 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grenada Diagnostic Radiology 1300 Sunset Dr Suite U Grenada MS 38901-4086 Ph: (662) 226-9279 | Grenada Diagnostic Radiology 1300 Sunset Dr Suite U Grenada MS 38901-4086 Ph: (662) 226-9279 |
| NPI Number | 1184685448 |
|---|---|
| Provider Enumeration Date | 03/28/2006 |
| Last Update Date | 12/23/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184685448 | NPI | - | NPPES |
| 00125988 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 222008 (Mississippi) | Primary |
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