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NPI Code Detail

MEDICARE: BEAUREGARD - VERNON MRI LLC

MEDICARE: BEAUREGARD - VERNON MRI 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
1293D00000XPhysiological Laboratory

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 : 1255330882
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEAUREGARD - VERNON MRI LLC
Provider Business Mailing Address
First Line : 600 S PINE ST
Second Line : MRI SUITE
City : DERIDDER
State : LA
Zip : 70634-4942
Country : US
Telephone Number : 337-462-9946
Fax Number : 337-462-9947
Provider Business Practice Location Address
First Line : 600 S PINE ST
Second Line : MRI SUITE
City : DERIDDER
State : LA
Zip : 70634-4942
Country : US
Telephone Number : 337-462-9946
Fax Number : 337-462-9947
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : JAMES W. HOLMES
Credential :
Telephone Number : 337-291-9161
Provider Enumeration Date : 07/15/2005
Last Update Date : 02/13/2015

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Directions to “BEAUREGARD - VERNON MRI LLC ” Practice Location

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