Provider Demographics
NPI:1710935929
Name:IMAGING CENTER OF MERIDIAN LLC
Entity type:Organization
Organization Name:IMAGING CENTER OF MERIDIAN LLC
Other - Org Name:<UNAVAIL>
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:504-459-3201
Mailing Address - Fax:504-883-5384
Practice Address - Street 1:2021 24TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3121
Practice Address - Country:US
Practice Address - Phone:601-483-4339
Practice Address - Fax:601-483-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02609273Medicaid
220258300OtherUS DEPT OF LABOR W/C
MS02609273Medicaid
=========OtherBLUE CROSS OF MS
=========OtherUNITED HEALTHCARE
=========OtherUNITED HEALTHCARE
Y18550Medicare UPIN