Active NPI
Gulf Coast Radiology LLC
- Diagnostic Radiology Physician
- Lake Charles, LA
National Provider Identifier
1326761925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- GULF COAST RADIOLOGY LLC
- Practice address
- 3000 Bayou Bend Rd
Lake Charles, LA 70605-3935 - Phone
- (337) 802-2802
- NPI assigned
- Sep 20, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David Richard Wallace Jr., MD
- Title
- Owner
- Phone
- (337) 802-2802
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | Primary |
Addresses
Primary practice location
3000 Bayou Bend Rd
Lake Charles, LA 70605-3935
Mailing address
3000 Bayou Bend Rd
Lake Charles, LA 70605-3935
Phone (337) 802-2802
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
1500 Line Ave
Ste 200
Shreveport, LA 71101
Phone (318) 629-5555
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Lake Charles, LA
- NPI 1265743595
-
- Diagnostic Radiology Physician
- Lake Charles, LA
- NPI 1336348549
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663632000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1663632000000",
"number": "1326761925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 BAYOU BEND RD",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706053935",
"telephone_number": "337-802-2802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 BAYOU BEND RD",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706053935",
"telephone_number": "337-802-2802"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GULF COAST RADIOLOGY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-09-20",
"last_updated": "2022-09-20",
"certification_date": "2022-09-20",
"status": "A",
"authorized_official_last_name": "WALLACE",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "RICHARD",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "337-802-2802",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
- Guillorys Transportation LLC
- Hayley Michelle Guinn
- Gulf Coast Behavior Services LLC
- Gulf Coast Nephrology, LLC
- Gulf Coast Psychiatry Services, LLC
- Gulf Coast Teaching Family Service, Inc.
- Gulf Coast Teaching Family Services, Inc.
- Gulf Coast Teaching Family Services, Inc.
- Gulf Coast Teaching Family Services, Inc.
- Gulf Coast Teaching Family Services, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.