| South Central Diagnostic Center | |
|
1440 Jefferson St Suite B Laurel MS 39440-4243 | |
| (601) 649-6213 | |
| (601) 649-6217 |
| Full Name | South Central Diagnostic Center |
|---|---|
| Speciality | General Practice |
| Location | 1440 Jefferson St, Laurel, Mississippi |
| Authorized Official Name and Position | James T Canizaro (CFO/VP OF FINANCE) |
| Authorized Official Contact | 6013996139 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Central Diagnostic Center Po Box 247 Laurel MS 39441-0247 Ph: (601) 425-7550 | South Central Diagnostic Center 1440 Jefferson St Suite B Laurel MS 39440-4243 Ph: (601) 649-6213 |
| NPI Number | 1619346863 |
|---|---|
| Provider Enumeration Date | 09/17/2015 |
| Last Update Date | 01/19/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619346863 | NPI | - | NPPES |
| 01880574 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 293D00000X | Physiological Laboratory | (* (Not Available)) | Secondary |
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