# SOUTH RYAN MRI, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southwest Louisiana Imaging
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376649061
- **Authorized official:** MR. CHARLES J. BRDLIK M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (337) 439-7778

## Contact information

- **Practice address:** 1601 COUNTRY CLUB RD, LAKE CHARLES, LA 70605-5325
- **Practice address phone:** (337) 439-7778
- **Practice address fax:** (337) 433-4686
- **Mailing address:** PO BOX 3184, LAKE CHARLES, LA 70602-3184
- **Mailing address phone:** (337) 439-7778
- **Mailing address fax:** (337) 433-4686

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085B0100X | Body Imaging Physician | — | NULL | Yes |
| 2085B0100X | Body Imaging Physician | — | — | Yes |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |

## Other

- **Enumeration date:** 09/16/2006
- **Last updated:** 03/05/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1445525 | — | LA |
| 01 | — | DA6047 | RAILROAD MEDICARE | LA |