Healthcare Provider Details

I. General information

NPI: 1184239899
Provider Name (Legal Business Name): EAGLE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 PETROLEUM DR
LAFAYETTE LA
70508-3880
US

IV. Provider business mailing address

204 PETROLEUM DR
LAFAYETTE LA
70508-3880
US

V. Phone/Fax

Practice location:
  • Phone: 337-266-9949
  • Fax: 337-266-9951
Mailing address:
  • Phone: 337-266-9949
  • Fax: 337-266-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID BARCZYK
Title or Position: SOLE MEMBER
Credential: DC
Phone: 337-266-9949