Provider Demographics
NPI:1124489265
Name:PALAFOX LEASING LLC
Entity type:Organization
Organization Name:PALAFOX LEASING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAMMIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-952-9141
Mailing Address - Street 1:PO BOX 78100
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:LA
Mailing Address - Zip Code:70837-8100
Mailing Address - Country:US
Mailing Address - Phone:225-930-0060
Mailing Address - Fax:225-952-9075
Practice Address - Street 1:42078 VETERANS AVE
Practice Address - Street 2:SUITE F
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1490
Practice Address - Country:US
Practice Address - Phone:985-340-1960
Practice Address - Fax:985-340-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA100762261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA449560Medicare PIN