1093784761 NPI number — ADVANCED IMAGING OF LAFAYETTE LLC

Table of content: (NPI 1093784761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093784761 NPI number — ADVANCED IMAGING OF LAFAYETTE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED IMAGING OF LAFAYETTE 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:
1093784761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18201 VON KARMAN AVE STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92612-1176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-544-3215
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 CAMELLIA BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70508-7084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
333-984-2036
Provider Business Practice Location Address Fax Number:
337-984-7604
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AMIN
Authorized Official First Name:
MINAL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
800-544-3215

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7266595 . This is a "AETNA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1601489 . This is a "UNITED OF LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2193687 . This is a "FIRST HEALTH/CCN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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