Provider Demographics
NPI:1558785899
Name:ULTRASOUND SERVICES OF LOUISIANA, LLC
Entity Type:Organization
Organization Name:ULTRASOUND SERVICES OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:VIDRINE
Authorized Official - Suffix:
Authorized Official - Credentials:CRA RT R N
Authorized Official - Phone:337-594-9637
Mailing Address - Street 1:174 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0720
Mailing Address - Country:US
Mailing Address - Phone:337-594-9637
Mailing Address - Fax:337-514-4268
Practice Address - Street 1:174 GRANT RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0720
Practice Address - Country:US
Practice Address - Phone:337-594-9637
Practice Address - Fax:337-514-4268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory