Provider Demographics
NPI:1568556256
Name:NORTHWEST IMAGING, LLC
Entity Type:Organization
Organization Name:NORTHWEST IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-930-0060
Mailing Address - Street 1:3500 N. CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-838-1200
Mailing Address - Fax:504-838-1239
Practice Address - Street 1:1460 E. BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 708
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-425-1001
Practice Address - Fax:318-425-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445045Medicaid
LA5CS24Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER