Healthcare Provider Details

I. General information

NPI: 1962747907
Provider Name (Legal Business Name): PARADIGM IMAGING, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64301 HIGHWAY 434
LACOMBE LA
70445-5411
US

IV. Provider business mailing address

PO BOX 1951
MANDEVILLE LA
70470-1951
US

V. Phone/Fax

Practice location:
  • Phone: 985-801-0581
  • Fax: 985-871-8109
Mailing address:
  • Phone: 985-801-0571
  • Fax: 985-871-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGG J MOREAU
Title or Position: CEO
Credential:
Phone: 985-801-0571