Provider Demographics
NPI:1689754103
Name:RADSOUTH IMAGING, LLP
Entity Type:Organization
Organization Name:RADSOUTH IMAGING, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:LAIRD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-296-0041
Mailing Address - Street 1:PO BOX 87080
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-8780
Mailing Address - Country:US
Mailing Address - Phone:225-296-0041
Mailing Address - Fax:225-296-0063
Practice Address - Street 1:9050 AIRLINE HIGHWAY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815
Practice Address - Country:US
Practice Address - Phone:225-924-8266
Practice Address - Fax:225-924-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1799963Medicaid
LA5B127Medicare ID - Type Unspecified