Organization
DESOTO DIAGNOSTIC IMAGING, LLC
Active
Other names
Methodist Diagnostic Center, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M GRAVES (PRESIDENT)
(901) 516-1410
Entity
Organization
Contact information
Practice address
9085 SANDIDGE CENTER COVE, SUITE 100, OLIVE BRANCH, MS 38654-3575
(662) 536-1000
(662) 893-8824
Mailing address
9085 SANDIDGE CENTER COVE, SUITE 100, OLIVE BRANCH, MS 38654-3575
(662) 536-1000
(662) 893-8824
Taxonomy
Speciality
Code
Description
License number
State
2471C3401X
Computed Tomography Radiologic Technologist
—
—
2471C3402X
Radiography Radiologic Technologist
—
—
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
Primary
—
—
2471M2300X
Mammography Radiologic Technologist
—
—
2471N0900X
Nuclear Medicine Technology Radiologic Technologist
—
—
2471S1302X
Sonography Radiologic Technologist
—
—
2471V0105X
Vascular Sonography Radiologic Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00973276
—
MS
Enumeration date
12/19/2006
Last updated
11/30/2011
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