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General NPI Number Information
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NPI Number | 1194807271
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC IMAGING ASSOCIATES
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 1453 E BERT KOUNS INDUSTRIAL LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71105-6800
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Country | US
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Telephone | 318-798-4300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3488 DEPT 05-042
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City | TUPELO
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State | MS
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Zip | 38803-3488
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Country | US
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Telephone | 855-896-8453
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Fax | 855-286-0483
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN HEBERT
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Credential | MD
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Telephone | 318-572-4403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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