1326207853 NPI number — PHYSICIANS IMAGING-IBERVILLE ASSOCIATES LLC

Table of content: (NPI 1326207853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326207853 NPI number — PHYSICIANS IMAGING-IBERVILLE ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS IMAGING-IBERVILLE ASSOCIATES 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:
1326207853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4650 LAKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70605-5416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-562-9711
Provider Business Mailing Address Fax Number:
337-562-9737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
59295 RIVER WEST DR
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
PLAQUEMINE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-238-0034
Provider Business Practice Location Address Fax Number:
225-238-0064
Provider Enumeration Date:
06/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
337-526-9711

Provider Taxonomy Codes

  • Taxonomy code: 247100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1039985 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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