Healthcare Provider Details

I. General information

NPI: 1033215710
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES OF SOUTHWEST LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 4TH ST
ALEXANDRIA LA
71301-8421
US

IV. Provider business mailing address

PO BOX 202233
DALLAS TX
75320-2233
US

V. Phone/Fax

Practice location:
  • Phone: 504-291-1063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN MARIE VAUGHN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 629-317-1465