| Organization Name: | BEAUREGARD - VERNON MRI LLC |
| NPI Number: | 1255330882 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES W. HOLMES (CHIEF OPERATING OFFICER) |
| Mailing Address: | 600 S Pine St Mri Suite Deridder |
| State: | LA US |
| Postal Code: | 706344942 |
| Phone Number: | 3374629946 |
| Fax Number: | 3374629947 |
| NPI Enumeration Date: | 07/15/2005 |
| NPI Last Update Date: | 02/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 293D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Laboratories |
| Taxonomy Classification: | Physiological Laboratory |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A laboratory that operates independently of a hospital and physician |