Basic Information
| Provider Information | |||||||||
| NPI: | 1326035502 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPOT IMAGING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 120 | ||||||||
| Address2: | |||||||||
| City: | MAMOU | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705540120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372615151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 POINCIANA AVE | ||||||||
| Address2: | |||||||||
| City: | MAMOU | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705542243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372615151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LAFLEUR | ||||||||
| AuthorizedOfficialFirstName: | DIANNE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MD | ||||||||
| AuthorizedOfficialTelephone: | 3372615151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1987611 | 05 | LA | MEDICAID |