Provider Demographics
NPI:1821320110
Name:ADVANCED IMAGING SPECIALTIES, LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING SPECIALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / MD
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COURVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-261-0928
Mailing Address - Street 1:5000 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:BLDG #1
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6984
Mailing Address - Country:US
Mailing Address - Phone:337-261-0928
Mailing Address - Fax:337-233-7773
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-4574
Practice Address - Country:US
Practice Address - Phone:337-261-0928
Practice Address - Fax:337-233-7773
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAFAYETTE HEART CLINIC INVESTMENTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA10913L01207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty