Healthcare Provider Details

I. General information

NPI: 1184619058
Provider Name (Legal Business Name): AVOYELLES OPEN MRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 CENTER ST
MARKSVILLE LA
71351-2841
US

IV. Provider business mailing address

319 CENTER ST PO BOX 465
MARKSVILLE LA
71351-2841
US

V. Phone/Fax

Practice location:
  • Phone: 318-253-7790
  • Fax: 318-253-7750
Mailing address:
  • Phone: 318-253-7790
  • Fax: 318-253-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRAD JOSEPH DEVILLE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 318-253-7790