Provider Demographics
NPI:1346202124
Name:MARIANNA RADIOLOGY
Entity type:Organization
Organization Name:MARIANNA RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAZABAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-824-4403
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-0357
Mailing Address - Country:US
Mailing Address - Phone:337-824-4403
Mailing Address - Fax:337-824-9731
Practice Address - Street 1:4250 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1917
Practice Address - Country:US
Practice Address - Phone:850-526-2200
Practice Address - Fax:850-718-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9412Medicare ID - Type Unspecified