Provider Demographics
NPI:1477792893
Name:PRECISION RADIOLOGY MANAGEMENT OF LOUISIANA LLC
Entity Type:Organization
Organization Name:PRECISION RADIOLOGY MANAGEMENT OF LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:337-704-0416
Mailing Address - Street 1:201 W VERMILION ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6847
Mailing Address - Country:US
Mailing Address - Phone:337-704-0416
Mailing Address - Fax:337-704-0417
Practice Address - Street 1:201 W VERMILION ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6847
Practice Address - Country:US
Practice Address - Phone:337-704-0416
Practice Address - Fax:337-704-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1462039Medicaid
MS06520221Medicaid
MS06520221Medicaid
LA5DH73Medicare PIN