Provider Demographics
NPI:1093061145
Name:NORTHEAST OUTPATIENT RADIOLOGY SERVICES
Entity Type:Organization
Organization Name:NORTHEAST OUTPATIENT RADIOLOGY SERVICES
Other - Org Name:SOUTH LOUISIANA OUTPATIENT RADIOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCROGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-630-6277
Mailing Address - Street 1:1005 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6834
Mailing Address - Country:US
Mailing Address - Phone:561-630-6277
Mailing Address - Fax:561-630-6062
Practice Address - Street 1:4545 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-5602
Practice Address - Country:US
Practice Address - Phone:561-630-6277
Practice Address - Fax:561-630-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology