Basic Information
| Provider Information | |||||||||
| NPI: | 1689754103 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADSOUTH IMAGING, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 87080 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708798780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252960041 | ||||||||
| FaxNumber: | 2252960063 | ||||||||
| Practice Location | |||||||||
| Address1: | 9050 AIRLINE HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259248266 | ||||||||
| FaxNumber: | 2259248242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 03/31/2010 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | TANYA | ||||||||
| AuthorizedOfficialMiddleName: | LAIRD | ||||||||
| AuthorizedOfficialTitleorPosition: | CLIENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2252960041 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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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 | 1799963 | 05 | LA | MEDICAID |