Basic Information
| Provider Information | |||||||||
| NPI: | 1083661003 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGY ASSOCIATES OF IBERIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 JEFFERSON ST STE 404 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705016991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373671048 | ||||||||
| FaxNumber: | 3373670131 | ||||||||
| Practice Location | |||||||||
| Address1: | 2315 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW IBERIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705604031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373671048 | ||||||||
| FaxNumber: | 3373670131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | SNELLGROVE | ||||||||
| AuthorizedOfficialFirstName: | BOYD | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3373671048 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1794325 | 05 | LA | MEDICAID |