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
—
—
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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