NPIMap

Organization Active NPI

South Ryan MRI, LLC

Doing business as Southwest Louisiana Imaging

  • Body Imaging Physician
  • Lake Charles, LA
National Provider Identifier
1376649061
Registry record updated Mar 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Body Imaging PhysicianTaxonomy code 2085B0100X
Legal business name
SOUTH RYAN MRI, LLC
Doing business as
Southwest Louisiana Imaging
Practice address
1601 Country Club Rd
Lake Charles, LA 70605-5325
Phone
(337) 439-7778
Fax
(337) 433-4686
NPI assigned
Sep 16, 2006
Last updated
Mar 5, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Charles J. Brdlik, M.D.
Title
Medical Director
Phone
(337) 439-7778

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085B0100X Primary
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X

Addresses

Primary practice location

1601 Country Club Rd
Lake Charles, LA 70605-5325

Mailing address

PO Box 3184
Lake Charles, LA 70602-3184
Phone (337) 439-7778

Other identifiers 2

IdentifierTypeStateIssuer
1445525MedicaidLA
DA6047OtherLARAILROAD MEDICARE

Other names 1

  • Southwest Louisiana Imaging Doing business as

National Provider Directory

National Provider Directory

Locations

1601 Country Club Rd
Lake Charles, LA 70605
Phone (337) 439-7778

650 S Ryan St
Lake Charles, LA 70601

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362441600000",
    "number": "1376649061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3184",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706023184",
            "telephone_number": "337-439-7778",
            "fax_number": "337-433-4686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 COUNTRY CLUB RD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706055325",
            "telephone_number": "337-439-7778",
            "fax_number": "337-433-4686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH RYAN MRI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2013-03-05",
        "status": "A",
        "authorized_official_last_name": "BRDLIK",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "337-439-7778",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1445525",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA6047",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Louisiana Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.