Provider Demographics
NPI:1457741852
Name:ST. CHRISTOPHER'S IMAGING, LLC
Entity Type:Organization
Organization Name:ST. CHRISTOPHER'S IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTORA
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS,RVT,ARRT
Authorized Official - Phone:318-658-9637
Mailing Address - Street 1:1725 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4502
Mailing Address - Country:US
Mailing Address - Phone:318-658-9637
Mailing Address - Fax:318-425-9189
Practice Address - Street 1:1725 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4502
Practice Address - Country:US
Practice Address - Phone:318-658-9637
Practice Address - Fax:318-425-9189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. CHRISTOPHER'S IMAGING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-23
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01957841335V00000X
LA335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2158554Medicaid
LA2158554Medicaid