Healthcare Provider Details

I. General information

NPI: 1235192352
Provider Name (Legal Business Name): JEFF DAVIS IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 ELTON RD
JENNINGS LA
70546-3614
US

IV. Provider business mailing address

P O BOX 357
JENNINGS LA
70546-0357
US

V. Phone/Fax

Practice location:
  • Phone: 337-616-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CHRIS SCHUMACHER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 337-616-7000