MEDICARE: RADIOLOGY IMAGING ASSOCIATES, LLP

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
1	2085B0100X	Body Imaging Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1265410583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY IMAGING ASSOCIATES, LLP

Provider Business Mailing Address
First Line	:	PO BOX 3509
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71133-3509
Country	:	US
Telephone Number	:	318-747-7370
Fax Number	:	318-747-2913

Provider Business Practice Location Address
First Line	:	2105 AIRLINE DR
Second Line	:	RADIOLOGY DEPARTMENT
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3105
Country	:	US
Telephone Number	:	318-741-6078
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KURT THOMAS GROZINGER
Credential	:	M.D.
Telephone Number	:	318-868-1559

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	08/22/2020

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