Organization
CALDWELL RADIOLOGY ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES CALDWELL MD (OWNER)
(337) 239-5148
Entity
Organization
Contact information
Practice address
1020 W FERTITTA BLVD, LEESVILLE, LA 71446-4649
(337) 239-5148
(337) 239-5318
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
(660) 826-4852
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1722669
—
LA
01
—
DE4858
RR MEDICARE
LA
Enumeration date
04/27/2007
Last updated
03/29/2011
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