Basic Information
| Provider Information | |||||||||
| NPI: | 1487676987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | US RADIOLOGY PARTNERS OF LOUISIANA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 E SHANKLAND AVE | ||||||||
| Address2: | |||||||||
| City: | JENNINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705464709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378244525 | ||||||||
| FaxNumber: | 3378244199 | ||||||||
| Practice Location | |||||||||
| Address1: | 4608 HIGHWAY 1 | ||||||||
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| City: | RACELAND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703942623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9855376841 | ||||||||
| FaxNumber: | 9855378272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 05/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | DARYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8665466643 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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 | 1441023 | 05 | LA | MEDICAID |