Healthcare Provider Details

I. General information

NPI: 1194760264
Provider Name (Legal Business Name): OUACHITA MEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008A LOUISVILLE AVE
MONROE LA
71201-6121
US

IV. Provider business mailing address

PO BOX 2144
MONROE LA
71207-2144
US

V. Phone/Fax

Practice location:
  • Phone: 318-398-2969
  • Fax:
Mailing address:
  • Phone: 318-398-2969
  • Fax:

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: JEFF SYLVESTER
Title or Position: PRESIDENT
Credential:
Phone: 318-398-2969