Organization
X-PRESS RAY OF OUACHITA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOMMY RAY BOLTON (OWNER)
(318) 329-5844
Entity
Organization
Contact information
Practice address
122 HERITAGE DRIVE, WEST MONROE, LA 71291-1420
(318) 329-5844
(318) 397-2420
Mailing address
122 HERITAGE DRIVE, WEST MONROE, LA 71291-1420
(318) 329-5844
(318) 397-2420
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
LA5080
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1121916
—
LA
01
—
630001709
RETIRED RR MEDICARE NATL
—
Enumeration date
11/13/2006
Last updated
07/23/2008
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