MEDICARE: DIGITAL IMAGING SERVICES OF LOUISIANA, 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	247100000X	Radiologic Technologist

General Provider Information

NPI Number	:	1609179852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGITAL IMAGING SERVICES OF LOUISIANA, LLC

Provider Business Mailing Address
First Line	:	2431 S ACADIAN THRUWAY STE 350
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-2374
Country	:	US
Telephone Number	:	225-926-3391
Fax Number	:	225-926-3389

Provider Business Practice Location Address
First Line	:	2431 S ACADIAN THRUWAY STE 350
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-2374
Country	:	US
Telephone Number	:	225-926-3391
Fax Number	:	225-926-3389

Authorized Official
Title or Position	:	EXECUTIVE VP
Name	:	KELLY ASHWORTH
Credential	:
Telephone Number	:	225-800-4954

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	03/01/2023

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