1568556256 NPI number — NORTHWEST 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 1568556256 NPI number — NORTHWEST IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST 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:
1568556256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 N. CAUSEWAY BLVD
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-838-1200
Provider Business Mailing Address Fax Number:
504-838-1239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1460 E. BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Practice Location Address:
SUITE 708
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-425-1001
Provider Business Practice Location Address Fax Number:
318-425-5001
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAUTHIER
Authorized Official First Name:
TAMRA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
225-930-0060

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1445045 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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