Provider Demographics
NPI:1083661003
Name:RADIOLOGY ASSOCIATES OF IBERIA
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF IBERIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SNELLGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-367-1048
Mailing Address - Street 1:600 JEFFERSON ST STE 404
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6991
Mailing Address - Country:US
Mailing Address - Phone:337-367-1048
Mailing Address - Fax:337-367-0131
Practice Address - Street 1:2315 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4031
Practice Address - Country:US
Practice Address - Phone:337-367-1048
Practice Address - Fax:337-367-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1794325Medicaid
LACS6300Medicare PIN
LA5C074Medicare PIN