Organization
IMAGING CENTER AT GLOSTER CREEK VILLAGE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL SCHAEFER (COO)
(770) 300-0101
Entity
Organization
Contact information
Practice address
320 S GLOSTER ST, TUPELO, MS 38801-4748
(662) 841-7880
(662) 821-1888
Mailing address
320 S GLOSTER ST, TUPELO, MS 38801-4748
(662) 841-7880
(662) 821-1888
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016308
—
MS
01
—
123156800
DEPT OF LABOR #
—
01
—
DA0120
MEDICARE RAILROAD
—
Enumeration date
05/11/2006
Last updated
07/21/2022
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