Provider Demographics
NPI:1588023980
Name:LOUISIANA DIAGNOSTIC AND IMAGING
Entity Type:Organization
Organization Name:LOUISIANA DIAGNOSTIC AND IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-324-0905
Mailing Address - Street 1:5633 CORMIER RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70668-6316
Mailing Address - Country:US
Mailing Address - Phone:337-324-0905
Mailing Address - Fax:
Practice Address - Street 1:5633 CORMIER RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:LA
Practice Address - Zip Code:70668-6316
Practice Address - Country:US
Practice Address - Phone:337-324-0905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty