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NPI Code Detail

MEDICARE: NONINVASIVE VASCULAR LAB INC

MEDICARE: NONINVASIVE VASCULAR LAB INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085U0001XDiagnostic Ultrasound PhysicianLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669473138
Entity Type Code : Organization
Provider Name (Legal Business Name) : NONINVASIVE VASCULAR LAB INC
Provider Business Mailing Address
First Line : 602 N LEWIS ST
Second Line : STE 100
City : NEW IBERIA
State : LA
Zip : 70563-2093
Country : US
Telephone Number : 337-364-7226
Fax Number : 337-364-7238
Provider Business Practice Location Address
First Line : 602 N LEWIS ST
Second Line : STE 100
City : NEW IBERIA
State : LA
Zip : 70563-2093
Country : US
Telephone Number : 337-364-7226
Fax Number : 337-364-7238
Authorized Official
Title or Position : OWNER
Name : WILLIAM W HARKRIDER JR.
Credential : MD
Telephone Number : 337-364-7226
Provider Enumeration Date : 08/09/2005
Last Update Date : 07/21/2022

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