Provider Demographics
NPI:1598791188
Name:OGH IMAGING, LLC
Entity Type:Organization
Organization Name:OGH IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTRAPES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-662-0033
Mailing Address - Street 1:PO BOX 437
Mailing Address - Street 2:
Mailing Address - City:GRAND COTEAU
Mailing Address - State:LA
Mailing Address - Zip Code:70541-0437
Mailing Address - Country:US
Mailing Address - Phone:504-779-5942
Mailing Address - Fax:504-779-5945
Practice Address - Street 1:1341 1-49 S. SERVICE RD
Practice Address - Street 2:
Practice Address - City:GRAND COTEAU
Practice Address - State:LA
Practice Address - Zip Code:70541
Practice Address - Country:US
Practice Address - Phone:337-662-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DA13Medicare ID - Type Unspecified