Provider Demographics
NPI:1457350076
Name:NORTH SHORE MRI LLC
Entity Type:Organization
Organization Name:NORTH SHORE MRI LLC
Other - Org Name:
Other - Org Type:
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 1:19300 N 4TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8720
Mailing Address - Country:US
Mailing Address - Phone:985-871-6655
Mailing Address - Fax:985-871-5050
Practice Address - Street 1:19300 N 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8720
Practice Address - Country:US
Practice Address - Phone:985-871-6655
Practice Address - Fax:985-871-5050
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
LA1442054Medicaid
LA1442054Medicaid