Provider Demographics
NPI:1407880339
Name:BATON ROUGE RADIOLOGY GROUP INC
Entity Type:Organization
Organization Name:BATON ROUGE RADIOLOGY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRIGNAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-769-6700
Mailing Address - Street 1:PO BOX 14530
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-4530
Mailing Address - Country:US
Mailing Address - Phone:225-769-6700
Mailing Address - Fax:
Practice Address - Street 1:5422 DIJON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4315
Practice Address - Country:US
Practice Address - Phone:225-769-9337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1145998Medicaid
LA1145998Medicaid