Healthcare Provider Details

I. General information

NPI: 1326207853
Provider Name (Legal Business Name): PHYSICIANS IMAGING-IBERVILLE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59295 RIVER WEST DR SUITE D
PLAQUEMINE LA
70764
US

IV. Provider business mailing address

4650 LAKE ST
LAKE CHARLES LA
70605-5416
US

V. Phone/Fax

Practice location:
  • Phone: 225-238-0034
  • Fax: 225-238-0064
Mailing address:
  • Phone: 337-562-9711
  • Fax: 337-562-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN H MCDONALD
Title or Position: CFO
Credential:
Phone: 337-526-9711