Basic Information
| Provider Information | |||||||||
| NPI: | 1811653991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMAGE NOW DIAGNOSTICS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1775 N COLUMBIA ST | ||||||||
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| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704335632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856356943 | ||||||||
| FaxNumber: | 9852316733 | ||||||||
| Practice Location | |||||||||
| Address1: | 69164 HIGHWAY 59 STE 4 | ||||||||
| Address2: | |||||||||
| City: | MANDEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704717782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856356943 | ||||||||
| FaxNumber: | 9852316733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2021 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | GAST | ||||||||
| AuthorizedOfficialFirstName: | LAUREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9856356943 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA, CPC | ||||||||
| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | N | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | 2471S1302X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Sonography |
No ID Information.