1801895578 NPI number — IMAGING CENTER OF LOUISIANA LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801895578 NPI number — IMAGING CENTER OF LOUISIANA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMAGING CENTER OF LOUISIANA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801895578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8338 SUMMA AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70809-3669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-761-8988
Provider Business Mailing Address Fax Number:
225-761-8940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8338 SUMMA AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-3669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-761-8988
Provider Business Practice Location Address Fax Number:
225-761-8940
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
337-291-9161

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1442216 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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