Provider Demographics
NPI:1942314521
Name:JEFFERSON PHYSICIAN IMAGING CENTER LLC
Entity Type:Organization
Organization Name:JEFFERSON PHYSICIAN IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-832-2115
Mailing Address - Street 1:1207 N CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-4129
Mailing Address - Country:US
Mailing Address - Phone:504-832-2115
Mailing Address - Fax:504-832-2116
Practice Address - Street 1:4809 WICHERS DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3026
Practice Address - Country:US
Practice Address - Phone:504-348-8132
Practice Address - Fax:504-348-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========0OtherBLUE CROSS OF LA
LA=========0OtherBLUE CROSS OF LA