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NPI Code Detail

MEDICARE: AWC LAB SERVICES

MEDICARE: AWC LAB SERVICES
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
1291U00000XClinical Medical Laboratory19D2093699LA

General Provider Information

NPI Number : 1851776892
Entity Type Code : Organization
Provider Name (Legal Business Name) : AWC LAB SERVICES
Provider Business Mailing Address
First Line : 150 CORA DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70815-4201
Country : US
Telephone Number : 225-387-1611
Fax Number : 225-343-5300
Provider Business Practice Location Address
First Line : 150 CORA DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70815-4201
Country : US
Telephone Number : 225-387-1611
Fax Number : 225-343-5300
Authorized Official
Title or Position : PRESIDENT
Name : MR. DWAYNE BEASON
Credential :
Telephone Number : 225-387-1611
Provider Enumeration Date : 07/20/2015
Last Update Date : 07/20/2015

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Directions to “AWC LAB SERVICES ” Practice Location

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