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NPI Code Detail

MEDICARE: ST. ELIZABETH IMAGING CENTER, LLC

MEDICARE: ST. ELIZABETH IMAGING 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
1261QR0200XRadiology Clinic/Center

General Provider Information

NPI Number : 1588942148
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. ELIZABETH IMAGING CENTER, LLC
Provider Business Mailing Address
First Line : 17609 OLD JEFFERSON HWY
Second Line : SUITE A
City : PRAIRIEVILLE
State : LA
Zip : 70769-3979
Country : US
Telephone Number : 225-924-2424
Fax Number : 225-408-7843
Provider Business Practice Location Address
First Line : 17609 OLD JEFFERSON HWY
Second Line : SUITE A
City : PRAIRIEVILLE
State : LA
Zip : 70769-3979
Country : US
Telephone Number : 225-924-2424
Fax Number : 225-408-7843
Authorized Official
Title or Position : CEO
Name : TREY WILLIAMSON
Credential :
Telephone Number : 225-924-2424
Provider Enumeration Date : 08/01/2011
Last Update Date : 08/01/2011

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