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Organization
SOUTH RYAN MRI, LLC
Active
Organization
SOUTH RYAN MRI, LLC
Active
Other names
Southwest Louisiana Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES J. BRDLIK M.D. (MEDICAL DIRECTOR)
(337) 439-7778
Entity
Organization
Contact information
Practice address
1601 COUNTRY CLUB RD, LAKE CHARLES, LA 70605-5325
(337) 439-7778
(337) 433-4686
Mailing address
PO BOX 3184, LAKE CHARLES, LA 70602-3184
(337) 439-7778
(337) 433-4686
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
—
NULL
2085B0100X
Body Imaging Physician
Primary
—
—
2085R0202X
Diagnostic Radiology Physician
—
NULL
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1445525
—
LA
01
—
DA6047
RAILROAD MEDICARE
LA
Enumeration date
09/16/2006
Last updated
03/05/2013
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