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General NPI Number Information
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NPI Number | 1336192863
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Entity Type | Organization
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Legal Business Name | REGIONAL RADIOLOGY, LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 1202 S TYLER ST
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City | COVINGTON
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State | LA
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Zip | 70433-2330
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Country | US
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Telephone | 985-898-4000
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Fax | 225-930-7524
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Provider Business Mailing Address
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Address Line | PO BOX 2189
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City | CHALMETTE
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State | LA
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Zip | 70044-2189
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Country | US
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Telephone | 504-277-0191
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Fax | 504-277-0195
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | ALLEN J LACOUR
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Credential | M.D.
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Telephone | 225-922-7961
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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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