Healthcare Provider Details

I. General information

NPI: 1508013079
Provider Name (Legal Business Name): SONOGRAPHERS-ON-SITE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 AMBASSADOR CAFFERY PKWY SUITE G-2
LAFAYETTE LA
70503-5280
US

IV. Provider business mailing address

PO BOX 52108
LAFAYETTE LA
70505-2108
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-3586
  • Fax: 337-456-3586
Mailing address:
  • Phone: 337-456-3586
  • Fax: 337-456-3586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number359485
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number359485
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number105496
License Number StateLA

VIII. Authorized Official

Name: JOSHUA A. PELLERIN
Title or Position: PRESIDENT
Credential: RDMS, RVS
Phone: 337-456-3586