Healthcare Provider Details

I. General information

NPI: 1669478889
Provider Name (Legal Business Name): HOUMA RADIOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 DUNN ST
HOUMA LA
70360-4765
US

IV. Provider business mailing address

PO BOX 3837
HOUMA LA
70361-3837
US

V. Phone/Fax

Practice location:
  • Phone: 985-876-2727
  • Fax: 985-851-7434
Mailing address:
  • Phone: 985-876-2727
  • Fax: 985-851-7434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1797731
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer

VIII. Authorized Official

Name: DR. J RICHARD THOMAS
Title or Position: PARTNER
Credential: MD
Phone: 985-876-2727