Provider Demographics
NPI:1093738478
Name:LOUISIANA PET IMAGING OF ALEXANDRIA, LLC
Entity Type:Organization
Organization Name:LOUISIANA PET IMAGING OF ALEXANDRIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-424-6486
Mailing Address - Street 1:920 PIERREMONT RD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-2079
Mailing Address - Country:US
Mailing Address - Phone:318-424-6486
Mailing Address - Fax:318-424-6487
Practice Address - Street 1:5419A JACKSON STREET EXT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2322
Practice Address - Country:US
Practice Address - Phone:318-441-2226
Practice Address - Fax:318-441-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA10218-L01261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C743Medicare ID - Type Unspecified