Provider Demographics
NPI:1730161936
Name:MED IMAGE MANAGEMENT & CONSULTANTS LLC
Entity type:Organization
Organization Name:MED IMAGE MANAGEMENT & CONSULTANTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:VIDRINE
Authorized Official - Suffix:
Authorized Official - Credentials:CRA RT R N
Authorized Official - Phone:337-594-9637
Mailing Address - Street 1:174 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0720
Mailing Address - Country:US
Mailing Address - Phone:337-594-9637
Mailing Address - Fax:337-948-4556
Practice Address - Street 1:174 GRANT RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0720
Practice Address - Country:US
Practice Address - Phone:337-594-9637
Practice Address - Fax:337-948-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10052085R0202X
LA10042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1664669Medicaid
LAP00238881OtherRAILROAD RETIREMENT MEDIC
LA1664669Medicaid
LA1664669Medicaid
LA=========0OtherBCBS