Provider Demographics
NPI:1790715738
Name:EAGLE RADIOLOGY LLC
Entity Type:Organization
Organization Name:EAGLE RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-473-6293
Mailing Address - Street 1:PO BOX 12670
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2670
Mailing Address - Country:US
Mailing Address - Phone:318-473-6293
Mailing Address - Fax:
Practice Address - Street 1:352 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71361
Practice Address - Country:US
Practice Address - Phone:318-473-6293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADC7001OtherRAILROAD MEDICARE
LA5CN69Medicare ID - Type Unspecified