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: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 NORTH BLVD
ALEXANDRIA LA
71301-3658
US

IV. Provider business mailing address

PO BOX 919112
DALLAS TX
75391-9112
US

V. Phone/Fax

Practice location:
  • Phone: 318-545-4038
  • Fax:
Mailing address:
  • Phone: 337-439-4706
  • Fax: 337-439-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WENDY LEE FOUNTAIN
Title or Position: DIRECTOR
Credential:
Phone: 321-331-4253