Provider Demographics
NPI:1154574887
Name:RADIOLOGIC-ON-SITE, LLC
Entity type:Organization
Organization Name:RADIOLOGIC-ON-SITE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PELLERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-456-3586
Mailing Address - Street 1:PO BOX 52108
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2108
Mailing Address - Country:US
Mailing Address - Phone:337-456-3586
Mailing Address - Fax:
Practice Address - Street 1:3909 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE G-2
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5280
Practice Address - Country:US
Practice Address - Phone:337-456-3586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3594852471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty