MEDICARE: LOURDES IMAGING CENTER LLC

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	2085R0202X	Diagnostic Radiology Physician

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	:	1174798771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOURDES IMAGING CENTER LLC

Provider Business Mailing Address
First Line	:	411 SAINT LANDRY ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-4623
Country	:	US
Telephone Number	:	337-233-6288
Fax Number	:	337-289-2782

Provider Business Practice Location Address
First Line	:	411 SAINT LANDRY ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-4623
Country	:	US
Telephone Number	:	337-233-6288
Fax Number	:	337-289-2782

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	KIM L. HEBERT
Credential	:
Telephone Number	:	337-289-4380

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	10/16/2008

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