Healthcare Provider Details

I. General information

NPI: 1376874594
Provider Name (Legal Business Name): VASCULAR SPECIALTY CENTER LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 SUMMA AVE FL 3 SUITE B
BATON ROUGE LA
70809-3720
US

IV. Provider business mailing address

8888 SUMMA AVE FL 3 SUITE B
BATON ROUGE LA
70809-3720
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-4266
  • Fax: 225-819-2976
Mailing address:
  • Phone: 225-769-4493
  • Fax: 225-766-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. NAOMI D NELSON
Title or Position: COO
Credential: MHA
Phone: 225-769-4493