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NPI Code Detail

MEDICARE: PET CENTER OF LOUISIANA LLC

MEDICARE: PET CENTER OF LOUISIANA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0208XMobile Radiology Clinic/Center445353LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093711426
Entity Type Code : Organization
Provider Name (Legal Business Name) : PET CENTER OF LOUISIANA LLC
Provider Business Mailing Address
First Line : PO BOX 6315
Second Line :
City : METAIRIE
State : LA
Zip : 70009-6315
Country : US
Telephone Number : 985-345-8867
Fax Number : 985-542-5322
Provider Business Practice Location Address
First Line : 1495 GAUSE BLVD
Second Line :
City : SLIDELL
State : LA
Zip : 70458-2205
Country : US
Telephone Number : 504-887-8728
Fax Number : 504-887-8702
Authorized Official
Title or Position : PARTNER
Name : DR. ROBERTO MARTINEZ JR.
Credential : MD
Telephone Number : 504-887-8728
Provider Enumeration Date : 06/21/2005
Last Update Date : 08/22/2020

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Directions to “PET CENTER OF LOUISIANA LLC ” Practice Location

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