Provider Demographics
NPI:1336193028
Name:PERKINS PLAZA IMAGING CENTER
Entity Type:Organization
Organization Name:PERKINS PLAZA IMAGING CENTER
Other - Org Name:LAKE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:225-765-8600
Mailing Address - Street 1:7135 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4322
Mailing Address - Country:US
Mailing Address - Phone:225-765-8600
Mailing Address - Fax:225-765-9956
Practice Address - Street 1:7135 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4322
Practice Address - Country:US
Practice Address - Phone:225-765-8600
Practice Address - Fax:225-765-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11392261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DD81Medicare PIN
LA5DA17Medicare PIN