Provider Demographics
NPI:1639166994
Name:OPELOUSAS RADIOLOGY GROUP LTD APMC
Entity Type:Organization
Organization Name:OPELOUSAS RADIOLOGY GROUP LTD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RO RISA
Authorized Official - Middle Name:
Authorized Official - Last Name:REINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-261-5151
Mailing Address - Street 1:PO BOX 52069
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2069
Mailing Address - Country:US
Mailing Address - Phone:337-261-5151
Mailing Address - Fax:
Practice Address - Street 1:1305 CROWLEY RAYNE HWY
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-8202
Practice Address - Country:US
Practice Address - Phone:337-261-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1794783Medicaid
LA5B960Medicare PIN
LA1794783Medicaid