Provider Demographics
NPI:1578546677
Name:ENVISION IMAGING OF ACADIANA LLC
Entity Type:Organization
Organization Name:ENVISION IMAGING OF ACADIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-955-4332
Mailing Address - Street 1:8610 EXPLORER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1058
Mailing Address - Country:US
Mailing Address - Phone:719-955-4140
Mailing Address - Fax:719-955-4148
Practice Address - Street 1:856B KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4210
Practice Address - Country:US
Practice Address - Phone:337-593-9500
Practice Address - Fax:337-593-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1164798Medicaid
LA1120413Medicaid
LA1123862Medicaid
LA1575437Medicaid
LA1123862Medicaid