Provider Demographics
NPI:1982634911
Name:ACADIANA DIAGNOSTIC IMAGING LLC
Entity Type:Organization
Organization Name:ACADIANA DIAGNOSTIC IMAGING LLC
Other - Org Name:ACADIANA MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SNELLGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-367-3910
Mailing Address - Street 1:PO BOX 3711
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-3711
Mailing Address - Country:US
Mailing Address - Phone:337-367-3910
Mailing Address - Fax:337-367-0131
Practice Address - Street 1:2309 E MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4046
Practice Address - Country:US
Practice Address - Phone:337-367-3910
Practice Address - Fax:337-367-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1440698Medicaid
LA1440698Medicaid
LA5C724Medicare PIN