Provider Demographics
NPI:1932108578
Name:OPEN MRI OF NORTHWEST LOUISIANA LLC
Entity Type:Organization
Organization Name:OPEN MRI OF NORTHWEST LOUISIANA LLC
Other - Org Name:ADVANCED DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-291-9161
Mailing Address - Street 1:855 PIERREMONT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-2084
Mailing Address - Country:US
Mailing Address - Phone:318-861-7413
Mailing Address - Fax:318-865-5792
Practice Address - Street 1:855 PIERREMONT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2084
Practice Address - Country:US
Practice Address - Phone:318-861-7413
Practice Address - Fax:318-865-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447421Medicaid
LAP00183753Medicare PIN
LA5CN13Medicare PIN