Provider Demographics
NPI:1629149414
Name:X-PRESS RAY OF OUACHITA LLC
Entity Type:Organization
Organization Name:X-PRESS RAY OF OUACHITA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-329-5844
Mailing Address - Street 1:122 HERITAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1420
Mailing Address - Country:US
Mailing Address - Phone:318-329-5844
Mailing Address - Fax:318-397-2420
Practice Address - Street 1:122 HERITAGE DRIVE
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-1420
Practice Address - Country:US
Practice Address - Phone:318-329-5844
Practice Address - Fax:318-397-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA5080335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
630001709OtherRETIRED RR MEDICARE NATL
LA1121916Medicaid
LA1121916Medicaid
LA19832Medicare ID - Type UnspecifiedNATIONAL