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General NPI Number Information
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NPI Number | 1093738478
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Entity Type | Organization
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Legal Business Name | LOUISIANA PET IMAGING OF ALEXANDRIA, LLC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5419A JACKSON STREET EXT
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2322
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Country | US
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Telephone | 318-441-2226
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Fax | 318-441-2240
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Provider Business Mailing Address
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Address Line | 920 PIERREMONT RD SUITE 411
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City | SHREVEPORT
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State | LA
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Zip | 71106-2079
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Country | US
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Telephone | 318-424-6486
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Fax | 318-424-6487
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. THOMAS HENRY COCHRAN
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Credential |
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Telephone | 318-424-6486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | LA10218-L01
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License Number State | LA
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