Provider Demographics
NPI:1326102633
Name:MOBILE X-RAY OF LOUISIANA, LLC
Entity Type:Organization
Organization Name:MOBILE X-RAY OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1987
Mailing Address - Street 1:910 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2450
Mailing Address - Country:US
Mailing Address - Phone:337-412-6702
Mailing Address - Fax:337-504-2158
Practice Address - Street 1:1021 COOLIDGE BLVD.
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-0000
Practice Address - Country:US
Practice Address - Phone:337-412-6702
Practice Address - Fax:337-504-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty