Healthcare Provider Details

I. General information

NPI: 1174577860
Provider Name (Legal Business Name): ACCUMED OF SOUTH LOUISIANA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7385 ALBERTA DR
BATON ROUGE LA
70808-4102
US

IV. Provider business mailing address

7385 ALBERTA DR
BATON ROUGE LA
70808-4102
US

V. Phone/Fax

Practice location:
  • Phone: 225-706-1101
  • Fax: 225-663-6778
Mailing address:
  • Phone: 225-706-1101
  • Fax: 225-663-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number1000686651
License Number StateLA

VIII. Authorized Official

Name: MR. PAUL J MORAN
Title or Position: PRESIDENT
Credential: MS
Phone: 225-706-1101