Provider Demographics
NPI:1982361424
Name:LIFETOUCH IMAGING LLC
Entity Type:Organization
Organization Name:LIFETOUCH IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:PEPPER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRASSEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:RVT, RDMS-AB
Authorized Official - Phone:337-288-0736
Mailing Address - Street 1:218 CALDWELL SUGAR RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6698
Mailing Address - Country:US
Mailing Address - Phone:337-288-0736
Mailing Address - Fax:
Practice Address - Street 1:218 CALDWELL SUGAR RD
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-6698
Practice Address - Country:US
Practice Address - Phone:337-288-0736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty