1548595564 NPI number — IBERVILLE IMAGING 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 1548595564 NPI number — IBERVILLE IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IBERVILLE IMAGING 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:
1548595564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59295 RIVER WEST DR
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
PLAQUEMINE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70764-6596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-238-0034
Provider Business Mailing Address Fax Number:
225-238-0064

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:
70764-6596
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:
10/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOY
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
225-761-8988

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)





Copyright © 2007-2026 www.npivalidator.com