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NPI Code Detail

MEDICARE: NORTHEAST IMAGING CENTER

MEDICARE: NORTHEAST IMAGING CENTER
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
1261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number : 1558864249
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEAST IMAGING CENTER
Provider Business Mailing Address
First Line : 4241 VETERANS MEMORIAL BLVD STE 200
Second Line :
City : METAIRIE
State : LA
Zip : 70006-5430
Country : US
Telephone Number : 888-273-3445
Fax Number : 504-883-5384
Provider Business Practice Location Address
First Line : 1703 LAMY LN
Second Line :
City : MONROE
State : LA
Zip : 71201-3737
Country : US
Telephone Number : 318-570-4985
Fax Number : 318-450-4040
Authorized Official
Title or Position : PRESIDENT
Name : JOHN STAGG
Credential :
Telephone Number : 225-270-7077
Provider Enumeration Date : 03/09/2018
Last Update Date : 09/13/2023

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