Provider Demographics
NPI:1578561999
Name:CENTRAL LOUISIANA IMAGING, INC.
Entity Type:Organization
Organization Name:CENTRAL LOUISIANA IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-442-8399
Mailing Address - Street 1:3704 NORTH BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3704 NORTH BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3606
Practice Address - Country:US
Practice Address - Phone:318-442-8399
Practice Address - Fax:318-448-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1948110Medicaid
LA1948110Medicaid
LA5C304Medicare ID - Type Unspecified