Basic Information
| Provider Information | |||||||||
| NPI: | 1598081085 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENVISION IMAGING OF ACADIANA, LLC | ||||||||
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| OtherOrganizationName: | RADIOLOGISTS OF ENVISION IMAGING OF ACADIANA | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8610 EXPLORER DR | ||||||||
| Address2: | STE 300 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809201058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7199554140 | ||||||||
| FaxNumber: | 7199554148 | ||||||||
| Practice Location | |||||||||
| Address1: | 856B KALISTE SALOOM RD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375939500 | ||||||||
| FaxNumber: | 3375930909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2010 | ||||||||
| LastUpdateDate: | 04/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7199554332 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 |
No ID Information.