Provider Demographics
NPI:1538127451
Name:BAYOU RADIOLOGY, INC
Entity Type:Organization
Organization Name:BAYOU RADIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RADIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARM EL'
Authorized Official - Middle Name:
Authorized Official - Last Name:BURAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-632-8355
Mailing Address - Street 1:200 W 134TH PL
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-4143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 W 134TH PL
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-4143
Practice Address - Country:US
Practice Address - Phone:985-632-8355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0261202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1136921Medicaid
MS09823071Medicaid
LA1136921Medicaid
LADG5461Medicare PIN