Organization
MOLECULAR IMAGING ASSOC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOE F JACOBS MD (OWNER)
(662) 334-9829
Entity
Organization
Contact information
Practice address
136 FIORANELLI DR, GREENVILLE, MS 38701-7313
(662) 334-9829
(662) 334-3529
Mailing address
136 FIORANELLI DR, GREENVILLE, MS 38701-7313
(662) 334-9829
(662) 334-3529
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
10589
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016013
—
MS
01
—
300132286
RAILROAD MEDICARE
MS
01
—
587403483
BLUE CROSS OF MS
MS
Enumeration date
06/05/2007
Last updated
07/13/2012
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