Provider Demographics
NPI:1801383245
Name:ST MARYS IMAGING CENTER II
Entity Type:Organization
Organization Name:ST MARYS IMAGING CENTER II
Other - Org Name:LOURDES IMAGING AT AMBASSADOR CAFFERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-470-2147
Mailing Address - Street 1:4809 AMBASSADOR CAFFERY PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8801
Mailing Address - Country:US
Mailing Address - Phone:337-470-7517
Mailing Address - Fax:
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY STE 350
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8801
Practice Address - Country:US
Practice Address - Phone:337-470-7517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty