Provider Demographics
NPI:1235259326
Name:ASCENSION OPEN MRI, LLC.
Entity Type:Organization
Organization Name:ASCENSION OPEN MRI, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-930-0060
Mailing Address - Street 1:PO BOX 14149
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-4149
Mailing Address - Country:US
Mailing Address - Phone:225-450-6125
Mailing Address - Fax:225-450-6327
Practice Address - Street 1:2622 SOUTH RUBY AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-450-6125
Practice Address - Fax:225-450-6327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1029742Medicaid
LA1029742Medicaid
LA5DA37Medicare PIN