Provider Demographics
NPI:1386816759
Name:IMAGING SERVICES OF LOUISIANA LLC
Entity Type:Organization
Organization Name:IMAGING SERVICES OF LOUISIANA LLC
Other - Org Name:DBA WOMEN'S IMAGING CENTRE-LAFAYETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING & ENROLLMENT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:LAVELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-344-8203
Mailing Address - Street 1:5000 AMBASSADOR CAFFERY PARKWAY BLDG 10
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-993-8300
Mailing Address - Fax:357-521-9159
Practice Address - Street 1:5000 AMBASSADOR CAFFERY PARKWAY BLDG 10
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-993-8300
Practice Address - Fax:357-521-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography