Healthcare Provider Details

I. General information

NPI: 1316983992
Provider Name (Legal Business Name): ABBEVILLE DIAGNOSIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 NORTH DR STE D
ABBEVILLE LA
70510-4042
US

IV. Provider business mailing address

PO BOX 53566
LAFAYETTE LA
70505-3566
US

V. Phone/Fax

Practice location:
  • Phone: 337-898-1249
  • Fax: 337-893-0071
Mailing address:
  • Phone: 337-898-1249
  • Fax: 337-893-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD M LAHASKY
Title or Position: MANAGEING MEMBER
Credential:
Phone: 337-898-1249