Provider Demographics
NPI:1902063449
Name:MCLEOD RADIOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:MCLEOD RADIOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-352-3492
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:130 EAST FIFTH STREET
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457
Mailing Address - Country:US
Mailing Address - Phone:318-352-3492
Mailing Address - Fax:318-352-3524
Practice Address - Street 1:501 KEYSER AVENUE
Practice Address - Street 2:NATCHITOCHES PARISH HOSPITAL
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457
Practice Address - Country:US
Practice Address - Phone:318-214-4274
Practice Address - Fax:318-214-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0099442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B89062Medicare UPIN
LA5DE51Medicare PIN