Provider Demographics
NPI:1477712156
Name:PHYSICIANS IMAGING-HOUMA ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PHYSICIANS IMAGING-HOUMA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-562-9711
Mailing Address - Street 1:4650 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5416
Mailing Address - Country:US
Mailing Address - Phone:337-562-9711
Mailing Address - Fax:337-562-9737
Practice Address - Street 1:132 VALHI LAGOON XING
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3208
Practice Address - Country:US
Practice Address - Phone:985-360-0834
Practice Address - Fax:985-360-0864
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS IMAGING-HOUMA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1040053Medicaid