MEDICARE: RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician
2	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH8188	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033215710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA

Provider Business Mailing Address
First Line	:	PO BOX 919112
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-9112
Country	:	US
Telephone Number	:	337-439-4706
Fax Number	:	337-439-8110

Provider Business Practice Location Address
First Line	:	3704 NORTH BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3658
Country	:	US
Telephone Number	:	318-545-4038
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	WENDY LEE FOUNTAIN
Credential	:
Telephone Number	:	321-331-4253

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/21/2025

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