Provider Demographics
NPI:1518014893
Name:OPEN IMAGING OF THE SOUTH LLC
Entity Type:Organization
Organization Name:OPEN IMAGING OF THE SOUTH LLC
Other - Org Name:PROSCAN IMAGING WEST BANK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-227-2282
Mailing Address - Street 1:4809 WICHERS DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3026
Mailing Address - Country:US
Mailing Address - Phone:504-227-2282
Mailing Address - Fax:
Practice Address - Street 1:4809 WICHERS DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3026
Practice Address - Country:US
Practice Address - Phone:504-227-2282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DA47Medicare PIN