Provider Demographics
NPI:1164811881
Name:DIAGNOSTIC AND INTERVENTIONAL MEDICINE, LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC AND INTERVENTIONAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:COMEAUX
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD, LLC
Authorized Official - Phone:225-408-2820
Mailing Address - Street 1:15475 AIRLINE HWY
Mailing Address - Street 2:BLDG C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-7314
Mailing Address - Country:US
Mailing Address - Phone:225-408-2820
Mailing Address - Fax:225-408-2829
Practice Address - Street 1:15475 AIRLINE HWY
Practice Address - Street 2:BLDG C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-7314
Practice Address - Country:US
Practice Address - Phone:225-408-2820
Practice Address - Fax:225-408-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD204025174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty