MEDICARE: CENTRAL 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

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	:	1912954520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL IMAGING CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 78100
Second Line	:
City	:	CENTRAL
State	:	LA
Zip	:	70837-8100
Country	:	US
Telephone Number	:	225-261-7401
Fax Number	:	225-261-3561

Provider Business Practice Location Address
First Line	:	11424 SULLIVAN RD
Second Line	:	BLDG. B - STE. C
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-3615
Country	:	US
Telephone Number	:	225-261-7401
Fax Number	:	225-261-3561

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. TAMRA GAUTHIER
Credential	:
Telephone Number	:	225-930-0060

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	11/23/2015

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