Provider Demographics
NPI:1134105869
Name:ACADIANA ONCOLOGIC IMAGING CENTER LLC
Entity Type:Organization
Organization Name:ACADIANA ONCOLOGIC IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-291-9161
Mailing Address - Street 1:2311 KALISTE SALOOM RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6807
Mailing Address - Country:US
Mailing Address - Phone:337-231-5775
Mailing Address - Fax:337-231-5776
Practice Address - Street 1:2311 KALISTE SALOOM RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6807
Practice Address - Country:US
Practice Address - Phone:337-231-5775
Practice Address - Fax:337-231-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1443697Medicaid
LA1443697Medicaid