Healthcare Provider Details

I. General information

NPI: 1336193028
Provider Name (Legal Business Name): PERKINS PLAZA IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7135 PERKINS RD
BATON ROUGE LA
70808-4322
US

IV. Provider business mailing address

7135 PERKINS RD
BATON ROUGE LA
70808-4322
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-8600
  • Fax: 225-765-5956
Mailing address:
  • Phone: 225-765-8600
  • Fax: 225-765-9956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number11392
License Number StateLA

VIII. Authorized Official

Name: DR. DANIEL MCNEILL JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 225-765-8600