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SOUTHEAST NEUROSCIENCE CENTER, LLC
NPI 1285630129
Specialist in Gray, LA

Active since June 24, 2005CLIA 19D2083528 · Waiver
128 NEUROSCIENCE CT, GRAY, LA 70359(985) 917-3007(985) 917-3010 Get Directions Write a Review

NPPES record last updated: April 23, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 23, 2026, Aug 20, 2016, Mar 23, 2016 (3 updates tracked since 2016).

About Southeast Neuroscience Center, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEAST NEUROSCIENCE CENTER, LLC (NPI 1285630129), doing business as Imaging Center Of South Louisiana, is a healthcare organization registered as a specialist in Gray, Louisiana and active in the NPI registry since June 2005. The organization holds a CLIA Waiver certificate valid through September 7, 2026 and lists Jasmine Martines, Billing, as its authorized official.

NPPES Registry Identity

NPI1285630129
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameSOUTHEAST NEUROSCIENCE CENTER, LLC
Location Address128 NEUROSCIENCE CTGray, LA 70359
Mailing Address128 Neuroscience CtGray, LA 70359-5209 · (985) 917-3007 · Fax (985) 917-3010
Phone(985) 917-3007
Fax(985) 917-3010
Organization SubpartNo
Authorized OfficialJasmine MartinesBilling · (985) 855-4327
Enumeration DateJune 24, 2005
Last NPPES UpdateApril 23, 20263 updates tracked since enumeration
NPPES CertifiedApril 23, 2026
✔ NPI 1285630129 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
128 NEUROSCIENCE CT, Gray, LA 70359
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Other Names 1

Doing Business AsImaging Center Of South Louisiana

Other Identifiers 1

Medicaid1947482LA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, HMO Louisiana.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 19D2083528

Southeast Neuroscience Center · Gray, LA
Active · expires Sep 7, 2026
CLIA Number19D2083528
Laboratory TypePhysician Office
Certificate Effective DateSeptember 8, 2024
Certificate Expiration DateSeptember 7, 2026
Laboratory DirectorDonald S. Gervais Jr
Laboratory Phone(985) 917-3007
Laboratory LocationSoutheast Neuroscience Center128 Neuroscience Court, Gray, LA 70359
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JEANETTE L NAQUIN FNP-C
Nurse Practitioner (Family)
128 NEUROSCIENCE CT
GRAY, LA 70359
Terrebonne Parish (985) 917-3007
BRITTANY MAE ROWELL
Physician Assistant
128 NEUROSCIENCE CT
GRAY, LA 70359
Terrebonne Parish (985) 917-3007
SAVANNAH PONTIFF
Nurse Practitioner
128 NEUROSCIENCE CT
GRAY, LA 70359
Terrebonne Parish (985) 917-3007
TAYLOR MICHELLE TANNER PA-C
Physician Assistant
128 NEUROSCIENCE CT
GRAY, LA 70359
Terrebonne Parish (985) 917-3007
AMANDA CHARPENTIER NP
Nurse Practitioner (Family)
128 NEUROSCIENCE CT
GRAY, LA 70359
Terrebonne Parish (985) 917-3007
DONALD SEVERINUS GERVAIS JR. M.D.
Psychiatry & Neurology (Neurology)
128 NEUROSCIENCE CT
GRAY, LA 70359
Terrebonne Parish (985) 917-3007
DR. WENDY SUDDETH GERVAIS M.D.
Radiology (Diagnostic Radiology)
128 NEUROSCIENCE CT
GRAY, LA 70359
Terrebonne Parish (985) 917-3007
EDWARD STEWART HAIGHT M.D.
Psychiatry & Neurology (Neurology)
128 NEUROSCIENCE CT
GRAY, LA 70359
Terrebonne Parish (985) 917-3007

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southeast Neuroscience Center, LLC's NPI number?

The NPI number for Southeast Neuroscience Center, LLC is 1285630129. It was assigned to this organization in the NPPES registry on June 24, 2005. The provider is doing business as Imaging Center of South Louisiana.

Where is Southeast Neuroscience Center, LLC located?

Southeast Neuroscience Center, LLC is located at 128 Neuroscience Ct, Gray, LA 70359. The listed phone number is (985) 917-3007.

What is Southeast Neuroscience Center, LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Southeast Neuroscience Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 19D2083528) is associated with this NPI, valid through September 7, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Southeast Neuroscience Center, LLC accept?

Health plans from Blue Cross and Blue Shield of Louisiana and HMO Louisiana list Southeast Neuroscience Center, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southeast Neuroscience Center, LLC was last updated on April 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.