Provider Demographics
NPI:1043255516
Name:SITTIG MOBILE X-RAY & CARDIOLOGY, INC.
Entity Type:Organization
Organization Name:SITTIG MOBILE X-RAY & CARDIOLOGY, INC.
Other - Org Name:SAME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:HABETZ
Authorized Official - Last Name:SITTIG
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:337-783-4196
Mailing Address - Street 1:711 N AVENUE K
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3848
Mailing Address - Country:US
Mailing Address - Phone:337-783-4196
Mailing Address - Fax:337-783-2400
Practice Address - Street 1:711 N AVENUE K
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3848
Practice Address - Country:US
Practice Address - Phone:337-783-4196
Practice Address - Fax:337-783-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19813335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA9571091OtherMUTUAL OF OMAHA PROV.NUM
LA37794OtherBLUE CROSS PROVIDER NUMBE
LA91151OtherSTERLING LIFE PAYER ID#
LA1373257Medicaid
LA37794OtherBLUE CROSS PROVIDER NUMBE