Provider Demographics
NPI:1487650933
Name:DELTA DIGITAL DIAGNOSTICS LLC
Entity type:Organization
Organization Name:DELTA DIGITAL DIAGNOSTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-405-5200
Mailing Address - Street 1:PO BOX 8861
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70011-8861
Mailing Address - Country:US
Mailing Address - Phone:985-405-5200
Mailing Address - Fax:985-405-5201
Practice Address - Street 1:1495 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2205
Practice Address - Country:US
Practice Address - Phone:985-405-5200
Practice Address - Fax:405-985-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447412Medicaid
LA1447412Medicaid