Healthcare Provider Details

I. General information

NPI: 1366411191
Provider Name (Legal Business Name): EXPRESS CARE DIAGNOSTICS OF SOUTHWEST LA., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HUGH WALLIS RD
LAFAYETTE LA
70508-2107
US

IV. Provider business mailing address

PO BOX 80735
LAFAYETTE LA
70598-0735
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-5456
  • Fax: 337-289-0119
Mailing address:
  • Phone: 281-346-0801
  • Fax: 281-346-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SHELIA LAUW
Title or Position: OWNER
Credential:
Phone: 281-346-0801