Provider Demographics
NPI:1649225673
Name:SOUTHERN DIAGNOSTIC CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHERN DIAGNOSTIC CENTER, INC.
Other - Org Name:LABORDE DIAGNOTICS AT SOUTH COLLEGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE CONTRACT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-5990
Mailing Address - Street 1:1101 S COLLEGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3038
Mailing Address - Country:US
Mailing Address - Phone:337-269-5990
Mailing Address - Fax:337-232-3295
Practice Address - Street 1:1101 S COLLEGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3038
Practice Address - Country:US
Practice Address - Phone:337-269-5990
Practice Address - Fax:337-232-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1793981Medicaid
LA300071001OtherMEDICARE RAILROAD RET
LA300071001OtherMEDICARE RAILROAD RET