Provider Demographics
NPI:1093825689
Name:SPECIALTY IMAGING L.L.C.
Entity Type:Organization
Organization Name:SPECIALTY IMAGING L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FORD
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-387-2235
Mailing Address - Street 1:111 MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5319
Mailing Address - Country:US
Mailing Address - Phone:318-387-2235
Mailing Address - Fax:318-388-4334
Practice Address - Street 1:111 MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5319
Practice Address - Country:US
Practice Address - Phone:318-387-2235
Practice Address - Fax:318-388-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)