Provider Demographics
NPI:1104855402
Name:RADIOLOGY ASSOCIATES A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HALSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-387-3453
Mailing Address - Street 1:1888 HUDSON CIR
Mailing Address - Street 2:STE 2
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3546
Mailing Address - Country:US
Mailing Address - Phone:318-387-3453
Mailing Address - Fax:318-323-9045
Practice Address - Street 1:1888 HUDSON CIR
Practice Address - Street 2:STE 2
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3546
Practice Address - Country:US
Practice Address - Phone:318-387-3453
Practice Address - Fax:318-323-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACK2617OtherRAILROAD MEDICARE
AR148439002Medicaid
LA1443867Medicaid
LA1443867Medicaid