Healthcare Provider Details

I. General information

NPI: 1861548075
Provider Name (Legal Business Name): PHYSICIANS IMAGING-SULPHUR MEDICAID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BEGLIS PKWY SUITE 2
SULPHUR LA
70663-3500
US

IV. Provider business mailing address

250 BEGLIS PKWY SUITE 2
SULPHUR LA
70663-3500
US

V. Phone/Fax

Practice location:
  • Phone: 337-310-8834
  • Fax:
Mailing address:
  • Phone: 337-310-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number StateLA

VIII. Authorized Official

Name: JOHN H. MCDONALD
Title or Position: CFO
Credential:
Phone: 337-310-8834