Provider Demographics
NPI:1386927952
Name:ST. ELIZABETH IMAGING LLC
Entity type:Organization
Organization Name:ST. ELIZABETH IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:N
Authorized Official - Last Name:LEJEUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-647-5071
Mailing Address - Street 1:1125 W HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5004
Mailing Address - Country:US
Mailing Address - Phone:225-647-5000
Mailing Address - Fax:
Practice Address - Street 1:17609 OLD JEFFERSON HWY
Practice Address - Street 2:SUITE B
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3979
Practice Address - Country:US
Practice Address - Phone:225-647-5071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology