Provider Demographics
NPI:1376685008
Name:LOUISIANA MEDICAL MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:LOUISIANA MEDICAL MANAGEMENT CORPORATION
Other - Org Name:CANAL RADIOLOGY LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:504-821-2574
Mailing Address - Street 1:2930 CANAL ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6367
Mailing Address - Country:US
Mailing Address - Phone:504-821-2574
Mailing Address - Fax:504-821-2595
Practice Address - Street 1:2930 CANAL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6367
Practice Address - Country:US
Practice Address - Phone:504-821-2574
Practice Address - Fax:504-821-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty