Healthcare Provider Details

I. General information

NPI: 1942284005
Provider Name (Legal Business Name): THE VASCULAR LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7648 PICARDY AVE SUITE 100
BATON ROUGE LA
70808-4694
US

IV. Provider business mailing address

7648 PICARDY AVE SUITE 100
BATON ROUGE LA
70808-4694
US

V. Phone/Fax

Practice location:
  • Phone: 225-819-8299
  • Fax: 225-766-3188
Mailing address:
  • Phone: 225-819-8299
  • Fax: 225-766-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number38161
License Number StateLA

VIII. Authorized Official

Name: CHRIS EMORY
Title or Position: TECHNICAL DIRECTOR
Credential: RVT
Phone: 225-819-8299