MEDICARE: ABBEVILLE DIAGNOSIC CENTER 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
1	261QR0200X	Radiology Clinic/Center

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	:	1316983992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABBEVILLE DIAGNOSIC CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 53566
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-3566
Country	:	US
Telephone Number	:	337-898-1249
Fax Number	:	337-893-0071

Provider Business Practice Location Address
First Line	:	2621 NORTH DR
Second Line	:	STE D
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-4042
Country	:	US
Telephone Number	:	337-898-1249
Fax Number	:	337-893-0071

Authorized Official
Title or Position	:	MANAGEING MEMBER
Name	:	DR. RONALD M LAHASKY
Credential	:
Telephone Number	:	337-898-1249

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	03/28/2008

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