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General NPI Number Information
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NPI Number | 1548227523
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Entity Type | Organization
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Legal Business Name | PET IMAGING OF SOUTHWEST LOUISIANA, LLC
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 600 BAYOU PINES EAST STE A
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City | LAKE CHARLES
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State | LA
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Zip | 70601
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Country | US
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Telephone | 337-493-5310
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Fax | 337-493-8524
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Provider Business Mailing Address
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Address Line | 600 BAYOU PINES EAST STE A
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City | LAKE CHARLES
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State | LA
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Zip | 70601
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Country | US
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Telephone | 337-493-5310
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Fax | 337-493-8524
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. REMY DANIEL MILLER
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Credential |
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Telephone | 337-493-5310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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