Dynamic Spinal Imaging of Swla, LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

DYNAMIC SPINAL IMAGING OF SWLA, LLC

Practice address

805 W Bayou Pines Dr
Suite D
Lake Charles, LA 70601-9605

Phone

(337) 602-6300

Fax

(337) 602-6339

NPI assigned

Sep 13, 2016

Organization subpart

No

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

Authorized official

Name

Dr. John R Condos, PHD

Title

President

Phone

(337) 602-6300

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1473724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473724800000",
    "number": "1972051548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 W BAYOU PINES DR",
            "address_2": "SUITE D",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706019605",
            "telephone_number": "337-602-6300",
            "fax_number": "337-602-6339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 W BAYOU PINES DR",
            "address_2": "SUITE D",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706019605",
            "telephone_number": "337-602-6300",
            "fax_number": "337-602-6339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC SPINAL IMAGING OF SWLA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-13",
        "last_updated": "2016-09-13",
        "status": "A",
        "authorized_official_last_name": "CONDOS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-602-6300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Radiology Clinic/Center in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Radiology Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; 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.