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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISA TEBAULT (OWNER / SOLE MEMBER)
(504) 221-9531
Entity
Organization

Contact information

Practice address
11650 WEST BARRINGTON DR, NEW ORLEANS, LA 70128
(504) 221-9531
Mailing address
PO BOX 29561, NEW ORLEANS, LA 70189-0561
(504) 221-9531

Taxonomy

Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
41808123K
LA

Other

Enumeration date
03/26/2015
Last updated
03/26/2015
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