Provider Demographics
NPI:1205018389
Name:PHYSICIANS IMAGING - IBERVILLE LLC
Entity Type:Organization
Organization Name:PHYSICIANS IMAGING - IBERVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-797-5541
Mailing Address - Street 1:59295 RIVER WEST DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764
Mailing Address - Country:US
Mailing Address - Phone:225-238-0034
Mailing Address - Fax:225-238-0064
Practice Address - Street 1:59295 RIVER WEST DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764
Practice Address - Country:US
Practice Address - Phone:225-238-0034
Practice Address - Fax:225-238-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty