Provider Demographics
NPI:1265410583
Name:RADIOLOGY IMAGING ASSOCIATES, LLP
Entity type:Organization
Organization Name:RADIOLOGY IMAGING ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GROZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-868-1559
Mailing Address - Street 1:PO BOX 3509
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-3509
Mailing Address - Country:US
Mailing Address - Phone:318-747-7370
Mailing Address - Fax:318-747-2913
Practice Address - Street 1:2105 AIRLINE DR
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3105
Practice Address - Country:US
Practice Address - Phone:318-741-6078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1338826Medicaid
LA1338826Medicaid