Healthcare Provider Details

I. General information

NPI: 1861247785
Provider Name (Legal Business Name): CMIT LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 KINGS HWY
SHREVEPORT LA
71103-4015
US

IV. Provider business mailing address

2120 KINGS HWY
SHREVEPORT LA
71103-4015
US

V. Phone/Fax

Practice location:
  • Phone: 318-716-4000
  • Fax: 318-716-4075
Mailing address:
  • Phone: 318-716-4000
  • Fax: 318-716-4075

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: STEPHEN JARED LOKITZ
Title or Position: INTERIM EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 318-716-4006