Organization
RIVERPARK IMAGING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCI L MCGRAW CFO (CFO)
(318) 336-2222
Entity
Organization
Contact information
Practice address
107 FRONT ST, VIDALIA, LA 71373-2836
(318) 336-2225
(318) 336-6060
Mailing address
107 FRONT ST, VIDALIA, LA 71373-2834
(318) 336-2225
(318) 336-6060
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
261QR0200X
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2415
BLUE CROSS PROVIDER# MS
MS
01
—
G7265
BLUE CROSS PROVIDER # LA
LA
Enumeration date
09/27/2005
Last updated
02/09/2012
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