Provider Demographics
NPI:1093784761
Name:ADVANCED IMAGING OF LAFAYETTE LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING OF LAFAYETTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MINAL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-544-3215
Mailing Address - Street 1:18201 VON KARMAN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1176
Mailing Address - Country:US
Mailing Address - Phone:800-544-3215
Mailing Address - Fax:
Practice Address - Street 1:935 CAMELLIA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7084
Practice Address - Country:US
Practice Address - Phone:333-984-2036
Practice Address - Fax:337-984-7604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7266595OtherAETNA
LA1601489OtherUNITED OF LA
LA2193687OtherFIRST HEALTH/CCN
LA1601489OtherUNITED OF LA
LA=========0OtherBCBS OF LOUISIANA
LA5CG37Medicare ID - Type UnspecifiedPART B MEDICARE