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NPI Code Detail

MEDICARE: OPELOUSAS RADIOLOGY GROUP LTD APMC

MEDICARE: OPELOUSAS RADIOLOGY GROUP LTD APMC
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
12085R0202XDiagnostic Radiology Physician

Other Identifiers

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

General Provider Information

NPI Number : 1639166994
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPELOUSAS RADIOLOGY GROUP LTD APMC
Provider Business Mailing Address
First Line : PO BOX 52069
Second Line :
City : LAFAYETTE
State : LA
Zip : 70505-2069
Country : US
Telephone Number : 337-261-5151
Fax Number :
Provider Business Practice Location Address
First Line : 1305 CROWLEY RAYNE HWY
Second Line :
City : CROWLEY
State : LA
Zip : 70526-8202
Country : US
Telephone Number : 337-261-5151
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. RO RISA REINA
Credential : MD
Telephone Number : 337-261-5151
Provider Enumeration Date : 10/03/2005
Last Update Date : 06/19/2015

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