Organization
MADISON IMAGING LLC
Active
Other names
dba Madison Medical Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENTON C. PARKER MD (PRESIDENT)
(601) 200-6162
Entity
Organization
Contact information
Practice address
106 HIGHLAND WAY, SUITE 100, MADISON, MS 39110
(601) 200-6162
(817) 317-7033
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0312
(817) 317-7033
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C03571
MEDICARE IDENTIFICATION
MS
Enumeration date
08/18/2006
Last updated
06/21/2018
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