Healthcare Provider Details

I. General information

NPI: 1144386301
Provider Name (Legal Business Name): STAT LABS I, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7049 PERKINS RD
BATON ROUGE LA
70808-4320
US

IV. Provider business mailing address

7049 PERKINS RD
BATON ROUGE LA
70808-4320
US

V. Phone/Fax

Practice location:
  • Phone: 225-757-1084
  • Fax: 225-757-0294
Mailing address:
  • Phone: 225-757-1084
  • Fax: 225-757-0294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number19D0990153
License Number StateLA

VIII. Authorized Official

Name: MR. DONALD DESHOTELS
Title or Position: MANAGER
Credential:
Phone: 225-757-1084